Scalpel vs Electrocautery for Upper Lateral Cartilage Contouring in Dorsal Preservation Rhinoplasty: A Retrospective Comparative Study

Abstract Background Dorsal preservation rhinoplasty maintains dorsum integrity while refining nasal aesthetics, but dorsal hump recurrence is a common limitation, especially after extensive reshaping. Electrocautery offers precise cartilage contouring, yet its role in dorsal preservation rhinoplasty is underinvestigated. Objectives To compare the outcomes of scalpel-based mechanical reshaping vs electrocautery-assisted thermal reshaping of the upper lateral cartilage shoulders in low septal strip dorsal preservation rhinoplasty. Methods The authors of this retrospective study included 205 patients who underwent low septal strip dorsal preservation rhinoplasty via the open approach between February 2021 and May 2023. Patients were grouped according to the method used for reshaping the upper lateral cartilage: Group I underwent mechanical reshaping with a scalpel (mechanical/scalpel group), and Group II underwent thermal reshaping using monopolar electrocautery (thermal/electrocautery group). Dorsal hump recurrence and patient-reported outcomes were evaluated using standardized 12-month postoperative photographs and the Rhinoplasty Outcome Evaluation (ROE) questionnaire, respectively. Results A total of 88 patients were included in the scalpel group and 117 in the electrocautery group. Demographic data, hump morphology, and amount of hump reduction were similar between groups. However, the recurrence rate of the dorsal hump was significantly lower in the electrocautery group (2.5%) than in the scalpel group (13.6%). ROE scores were high in both groups (84.4 vs 85.0, P > .05). Conclusions Electrocautery-assisted upper lateral cartilage reshaping in dorsal preservation rhinoplasty offers more consistent contouring and reduced recurrence rates compared with the scalpel-based technique. It represents a valuable technical adjunct, especially in patients with a challenging dorsal anatomy. Level of Evidence: 3 (Therapeutic)