The Truth About Dorsal Preservation vs. Component Reduction: How I Choose the Right Approach

The Truth About Dorsal Preservation vs. Component Reduction: How I Choose the Right Approach

If you’ve researched rhinoplasty online, you’ve probably come across the terms dorsal preservation and component reduction. These are two different ways to address the nasal dorsum (the bridge of the nose), and both have become popular topics in the rhinoplasty community.

In my practice, I have done both. My preference is component reduction. For me, its more predictable and safe. I have largely moved away from preservation techniques.

In this article, I’ll break down what each technique actually means, how they differ, the pros and cons of each, and how I decide which is most appropriate during rhinoplasty.

What is Dorsal Preservation Rhinoplasty?

Dorsal preservation (DP) is a technique where, instead of removing the dorsal hump and reconstructing the bridge, the surgeon pushes the dorsum down.

The goal:

  • to not “open the roof of the nose” and thus not need to reconstruct the roof.

How it works:

Rather than reducing the hump directly, DP involves:

  • complex bone cuts and septal cuts to release the nose and allow it to hinge down.

In my experience, I think noses look better with component hump reduction in my hands. It also avoids a residual hump or hump recurrence that can occur in dorsal preservaiton.

What is Component Reduction Rhinoplasty?

Component reduction is the more common, traditional structural approach where the dorsum lowered by hump removal. If the hump is big it needs to be supported again. If small it can simply be shaved.

This involves:

  • Refining bone with power tools or ultrasonic instrumentation

  • Adding spreader grafts or auto-spreader flaps when needed

  • and incrementally changing the profile for precision.

This approach gives the surgeon complete control over the shape, symmetry, and internal structure of the dorsum.

Pros and Cons of Dorsal Preservation

Pros

  • no midvault reconstruction

Cons

  • Limited to very specific anatomy

  • Less precise control

  • Harder to correct crookedness or asymmetry

  • Not ideal in revision cases

  • Can produce unpredictable long-term changes if the anatomy isn’t ideal

  • recurrence of a hump

  • challenging revision if needed.

In my practice:

  • Most patients do best with component dorsal reduction (because it’s more precise, customizable, and stable).

If a patient is seeking dorsal preservation we can discuss if theyre a good candidate as I have done the full spectrum of DP.

Bottom Line

The goal is a beautiful nose that lasts forever and still works. I prefer component reduction over DP. DP I did for a full year and did hundred of patients. I learned important information during that time, but I know in my hands DP isnt the best choice.

If you’re considering rhinoplasty or revision rhinoplasty and want a tailored, modern structural approach, click here to book a consultation with Dr. Hyman.

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