Rhinoplasty Aesthetic Surgery Journal Commentary 2018, Vol 38(2) 132 © 2018 The American Society for Aesthetic Plastic Surgery, Inc. Commentary on: Dorsal Preservation: The Reprints and permission: email@example.com Push Down Technique Reassessed DOI: 10.1093/asj/sjx240 www.aestheticsurgeryjournal.com Eugene B. Kern, MD Editorial Decision date: November 10, 2017. Some time ago, in 2010, I was visiting my esteemed col- the authors of this article conclude, “…surgeons should league and friend, the great Mexican functional rhinolo- consider incorporating dorsal preservation techniques in gist and cosmetic rhinoplasty surgeon, Dr Fausto Lopez their surgical armamentarium rather than relying solely Infante (1935-2013). I asked him how often he performed on the Joseph reduction method…” The data and tech- dorsal preservation procedures in rhinoplasty such as the niques presented in this paper were clearly and convinc- push down or let down operations. He paused for not more ingly presented and should be seriously considered by the than a blink and earnestly stated, “For the first 10 years rhinoplasty surgeon in a number of selected cases—if not of practice I did the Push Down; the next 10 years I chis- in many primary cases—so as not to rely solely on one eled off the dorsum. What do you think I did for this last technique to reduce a dorsal nasal “hump” deformity. 10 years?” As I remember that instant in time, I said, “You Disclosures returned to the push down or let down.” “Exactly,” he replied, “because I loved the smooth dorsum and avoiding The author declared no potential conflicts of interest with respect the postoperative disrupted K-area with the attendant dor- to the research, authorship, and publication of this article. sal irregularities. And of course, I did not like the infracture Funding needed to close the open roof that at times narrowed the nasal valve angle and area producing postoperative breath- The author received no financial support for the research, ing disturbances.” authorship, and publication of this article. Today, as in the past, I personally respect and champion dorsal preservation techniques, when feasible, especially REFERENCE in primary rhinoplasty, which is often, as proposed with 1. Saban Y, Daniel RK, Polselli R, Trapasso M, Palhazi P. the push down operation (PDO) of Dr Maurice H. Cottle, Dorsal preservation: the push down technique reassessed. of Chicago in the United States, or the let down operation Aesthet Surg J. 2018;38(2): 117–131. (LDO) championed by Drs Vernon Grey, of Los Angeles in the United States, and Egbert Huizing of Utrecht in the Netherlands, and by the authors of this present article. Dr Kern is Endicott Professor of Medicine, Emeritus, Mayo The versatile surgeon commands a greater number of Foundation for Medical Education and Research; Professor of technical options at their disposal which may be selected, Rhinology and Facial Plastic Surgery, Emeritus, Mayo Clinic School when needed, for specific cases, whether approaching the of Medicine; and Clinical Professor of Otorhinolaryngology, State rhinoplasty through an external (open) approach or an University of New York (SUNY) at Buffalo, Buffalo, NY. endonasal (closed) approach. Preserving the dorsum while Corresponding Author: reducing the “hump” (a better term, in my opinion, is Dr Eugene B. Kern, Department of Otorhinolaryngology, SUNY at “dorsal nasal deformity”) avoids dorsal irregularities and Buffalo, Vice President Gromo Foundation for Medical Education a potentially unsightly inverted-V-shaped deformity, along and Research, 1237 Delaware Ave., Buffalo, NY 14209, USA. with probable breathing dysfunction postoperatively. As E-mail: firstname.lastname@example.org Downloaded from https://academic.oup.com/asj/article-abstract/38/2/132/4793280 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Aesthetic Surgery Journal – Oxford University Press
Published: Feb 1, 2018
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