Aesthetic, functional, and radiological outcomes of nasal ligament and alar cartilage preservation versus non-preservation in primary rhinoplasty: a prospective pilot comparative cohort study

Abstract Background Preservation rhinoplasty aims to preserve natural nasal structures, in contrast to traditional methods that involve cartilage excision or significant modification. Recent advances prioritize preserving the nasal dorsum, soft-tissue envelope, and nasal cartilage, potentially reducing postoperative complications and improving outcomes. This prospective pilot comparative cohort study evaluated immediate postoperative outcomes of nasal tip ligament and alar cartilage preservation techniques in primary rhinoplasty compared with non-preservation techniques. Outcomes included: aesthetic evaluation (Rhinoplasty Assessment Scale–Photographic, RAS-P), functional assessment (Nasal Obstruction Symptom Evaluation, NOSE), radiologic evaluation (ultrasound-measured tip and supratip thickness and CT-based internal nasal valve angle), and patient-reported satisfaction (Rhinoplasty Outcome Evaluation, ROE). Results Our study included thirty cases of primary rhinoplasty (14 females, 16 males; mean age 26.3 ± 6.25 years). The mean postoperative follow-up period was 6 months. Both the preservation and non-preservation cohorts demonstrated statistically significant postoperative improvements in NOSE, ROE, and RAS-P scores ( p < 0.001 for all comparisons). No statistically significant differences were observed between groups for postoperative nasal valve angles, RAS-P scores, or percentage change in functional or aesthetic outcomes. Tip grafts were used significantly more frequently in the preservation cohort (53.3% vs 6.7%, p = 0.034). Ultrasound demonstrated a significant postoperative increase in nasal tip thickness in both groups. Supratip thickness increased significantly in the non-preservation group, while no significant change was observed in the preservation group; however, the between-group interaction did not reach statistical significance ( p = 0.06). Conclusion This study demonstrates that both preservation and non-preservation techniques of the nasal ligaments and cartilages improve nasal function and aesthetics, with neither technique showing clear superiority. However, the study was underpowered, and these findings should be interpreted as preliminary rather than indicative of equivalence. Preservation rhinoplasty was associated with a significantly higher frequency of tip graft use. It showed no significant postoperative increase in supratip thickness, whereas the non-preservation group did.