Objective. To determine the optimal algorithm for optimal nasal back correction in primary rhinoplasty based on preoperative planning and wishes of the patient.

Material and methods. We analyzed 385 primary rhinoplasty procedures. The study included patients with a minimum follow-up period of 1 year who underwent the following stages of surgical intervention: detachment of soft tissues, preservation of ligaments, changing the support of the tip of the nose, work with lateral crura, installation of various grafts on the alar cartilages and the tip of the nose. The type of surgery depended on cephalometric parameters and aesthetic wishes of the patient. All patients were divided into three groups: complete preservation of the back of the nose; partial preservation of the back of the nose; conventional work with the back of the nose including opening, strengthening and fixing the back of the nose. All patients experienced complete preservation of soft tissues of nasal dorsum. Detachment was performed in subperichondral layer. A piezotome was used for osteotomy in all cases.

Results. Open technique was used in 112 (29%) patients, closed procedure — in 273 (71%) patients, complete preservation of nasal dorsum — 107 (28%) patients, partial removal of nasal dorsum hump — 228 (59%) patients, traditional work with nasal dorsum — 50 (13%) patients.

Conclusion. Cephalometric analysis is essential in decision making on manipulations with nasal dorsum during primary rhinoplasty. Analysis of anatomical and physiological characteristics of the nose, functions and complaints of patients is mandatory. Precise photography, assessment of soft tissue thickness, skin characteristics (elasticity, porosity), analysis of CT data (bone structures and their relationship with soft tissues) are an integral part of preoperative management. Decision-making algorithm for optimal nasal back correction greatly simplifies primary rhinoplasty with maximum aesthetic and functional results.

Keywords. sparing rhinoplasty, structural rhinoplasty, subperichondral dissection, nasal dorsum, hump, internal nasal valve