Narrowing the Nasal Roof with Paramedial Osteotomy in Preservation Rhinoplasty

Introduction Rhinoplasty is frequently performed in aesthetic and plastic surgery, with hump deformity being common in Western populations. Osteotomies play a crucial role in managing this, especially for dorsal hump reduction in closed rhinoplasty. Objectives Despite advancements, treatments for simultaneous nasal hump deformity and wide nasal roof are inadequate in preservation rhinoplasty. This study introduces a technique merging push-down and let-down methods with paramedial osteotomy for these cases. Methods A retrospective review was conducted on patients undergoing push-down or let-down rhinoplasty, identifying 68 individuals (51 females and 17 males) with both nasal hump deformity and wide nasal roof. They were evaluated using the Rhinoplasty Outcome Evaluation questionnaire before surgery and 1-year post-operation. Results Follow-up ranged from 12 to 24 months, with significant improvement in patient satisfaction. The median Rhinoplasty Outcome Evaluation score rose from 48.5 pre-surgery to 91.5 post-surgery (p < 0.001), indicating remarkable patient satisfaction in 97.3% of cases. Conclusion This research is to demonstrate narrowing the nasal roof in patients who had nasal hump deformity and wide nasal roof with a combination of dorsal preservation techniques and osteotomy. Surgeons experienced in push-down or let-down techniques can apply this combination technique to obtain better aesthetic outcomes in patients with a wide nasal roof.