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Background: The dorsal roof flap (DRF) technique was developed as a modification of the retractable roof method, which is a variant of dorsal preservation (DP)., Objective: The paper aims to present new results of the DRF technique and dorsal deformity analysis created for the technique., Methods: A total of 57 primary rhinoplasty patients treated with DRF technique between 2022-2023 years were included in the study. A dorsal deformity classification based on the anticipated amount of dorsal reduction, nasal bone shape, and hump content was used. According to the classification, the noses were categorized into 3 types. All data were obtained from patient records, computed tomography views, and pre-and postoperative photographs. Aesthetic and functional results were assessed pre-and postoperatively using a visual analog scale (VAS) (0-10, 0 points means very poor)., Results: The mean follow-up period was 10.1 ± 3.9 months. 23 cases were type 1, 14 were type 2, and 20 were type 3. The anticipated amount of dorsal reduction in type 1 was 2-4 mm, 5-7 mm in type 2, and 8-10 mm in type 3 deformity. Of the total, 27 cases had a V-shaped nasal bone and 30 had an S-shaped. The hump composition was cartilaginous in 13 cases and bone and cartilage in 44 cases. Pre- and postoperative aesthetic and functional VAS scores were significantly different (p ≤ 0.001). No complications and therefore no revisions were observed during the follow-up period., Conclusion: It is a versatile method to reshape the nasal dorsum and minimize the revisions associated with dorsal preservation when used in appropriate cases., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Management of the nasal dorsum remains a challenge in rhinoplasty surgery. Currently, the majority of reduction rhinoplasties results in destruction of the keystone area (K-area), which requires reconstruction with either spreader grafts or spreader flaps, both for aesthetic and functional reasons. This article will present the senior author's current operative technique for dorsal preservation in reduction rhinoplasty based on 320 clinical cases performed over a 5-year period. The author's operative technique is as follows: (1) endonasal approach; (2) removal of a septal strip in the subdorsal area whose shape and height were determined preoperatively; (3) complete lateral, transverse, and radix osteotomies; and (4) dorsal reduction utilizing either a push down operation (PDO) or a let down operation (LDO). The PDO consists of downward impaction of the fully mobilized nasal pyramid and is utilized in patients with smaller humps (Less than 4 mm). The LDO consists of a maxillary wedge resection and is performed in patients who need more than 4 mm of lowering. A total of 320 patients had a dorsal preservation operation (DPO). Postoperatively, there were no dorsal irregularities nor inverted-V deformities. Among our 44 personal revision cases, 27 patients (8.74%) had had a previous DPO, 16 of whom required tip revisions with no further dorsal surgery. Of the remaining 11 patients, the main problems were either hump recurrence and/or lateral deviation of the dorsum or widening of the middle third, which required simple surgical revision. Based on the authors' experience, adoption of a PDO/LDO is justified in selected primary patients. The key question before any primary rhinoplasty procedure should be "Can I keep the nasal dorsum intact?" Precise analysis and surgical execution are required to preserve the dorsal osseocartilaginous vault and K-area. Dorsal preservation results in more natural postoperative dorsum lines and a "not operated" aspect without the need for midvault reconstruction. Moreover, this technique is quick and easy to perform by any rhinoplasty surgeon. Rhinoplasty surgeons should consider incorporating dorsal preservation techniques in their surgical armamentarium rather than relying solely on the Joseph reduction method or an open structure rhinoplasty., (© 2018 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.)

Objective: The authors developed an original and simple method of evaluation of the aesthetic lines of the nose adapted to the harmony of the face., Method: Initially based on their experience, the authors propose an evaluation of the nose in 2 stages and 5 sequencies based on the construction of single circuit lines according to various incidences. They checked thereafter the validity of this method on the operative project and on the appreciation of the results of the rhinoplasties., Results: Controlled on several types of faces, the method suggested by the authors proved to be reliable, simple, reproducible., Conclusion: The authors proposed a method of evaluation of the aesthetic lines of the nose integrated to the harmony of the face. This method relies on the construction, in 5 stages, of single circuit lines not requiring any particular material. The artistic method of evaluation of the nose proposed by the authors is very simple. Rapid and immediately usable, it makes it possible to schedule a rhinoplasty in a few minutes. The evaluation of the aesthetic results of the rhinoplasties is also very simple and reproducible. It has moreover the merit to propose a model of teaching making it possible to the rhinoplastician to criticize his results and thus to progress in its technical training and its operational indications.