Management of the nasal dorsum in rhinoplasty: A systematic review of the literature regarding technique, outcomes, and complications

Background: Few operations in plastic surgery have generated as much discussion and debate as that of rhinoplasty. The aim of this review is to explore the existing body of literature with regard to techniques addressing the nasal dorsum. The authors' attempt was to isolate those articles providing either retrospective or prospective data pertaining to outcomes and complications of the implemented technique(s). MethodS: A comprehensive review of the literature was conducted consisting of articles published between January 1, 1950, and September 1, 2010. The search included MEDLINE by means of OVID and PubMed in addition to the Cochrane database. Through aggressive investigation, the review was supplemented with articles not initially identified that met inclusion criteria. Results: Of the 5437 articles returned from the initial search, 115 were initially selected on the basis of abstract review. Of these, 59 met the predetermined criteria for inclusion. An additional 24 articles meeting criteria were identified. Of note, some articles provided both augmentation and reduction data. Eighty-nine percent of studies focused on augmentation, showing acceptable results with generally low levels of complications with use of various types of cartilage, bone, and soft tissue. Use of synthetic implants such as Gore-Tex and silicone showed higher complication rates, including displacement and extrusion, but overall acceptable results. Dorsal reduction was reviewed in 13 percent of studies, with a multitude of approaches, presenting mostly satisfactory results. Conclusions: A vast majority of the published data related to management of the nasal dorsum is low-level evidence. Future studies should aim to provide level II or III evidence.