Dorsal Flattening with Periosteal Tensioning: Management of the Central Keystone Blocking Point in Dorsal Preservation Rhinoplasty: A Clinical and Anatomic Study

The most common unwanted outcomes in preservation rhinoplasty continue to be the residual and the recurrent hump.We propose a new solution, contributing to preexisting techniques, to overcome this obstacle.Our study shows evidence from cadaveric dissection and in 204 clinical cases since 2020, with a median follow-up of 12 months.Careful dissection of not only the lateral, but also the central keystone area, enables a sliding motion of the kyphotic cartilaginous hump under the bony vault and releases the recoil forces causing the spring effect. Further flattening and stabilization of the straightened dorsum is achieved by tensioning the connection between bone and cartilage with a periosteal flap.The postoperative results were stable, and no hump recurrence was observed.With this method, a broader spectrum of deformities could be treated with preservation rhinoplasty.