Modern Rhinoplasty: integrating anatomic preservation, structural support, and respiratory function - a narrative review

Abstract

Introduction: Contemporary rhinoplasty seeks to balance aesthetic refinement, biomechanical stability, and maintenance or improvement of nasal airflow. A rigid opposition between structural and preservation techniques cannot reflect the complexity of individualized planning. Objective: To discuss anatomical foundations, preoperative assessment, technique selection, and safety in modern rhinoplasty. Methods: Critical narrative review of clinical guidelines and indexed literature available through October 2026; no original systematic review or meta-analysis was performed. Discussion: Nasal valve anatomy, open and endonasal approaches, dorsal surgery, preservation techniques, structural grafts, tip refinement, septal correction, and revision surgery are examined. Patient-reported outcomes, adverse events, and longitudinal follow-up are also considered. Synthesis: Current evidence supports anatomy-guided decisions, favoring preservation when feasible and structural reconstruction when required. Recent systematic reviews describe satisfactory results with both strategies but do not establish universal superiority for either one. Conclusion: Technique selection should be driven by deformity characteristics, respiratory function, tissue quality, and realistic expectations, with follow-up long enough to capture scar maturation and stable functional outcomes.