Advances in conservative rhinoplasty techniques for complex noses: anatomical fundamentals, surgical strategies, and long-term aesthetic and functional outcomes

Introduction: Preservative rhinoplasty represents a paradigm shift in nasal surgery, prioritizing the maintenance of the dorsal osteocartilaginous framework as opposed to classic reductive techniques.In complex noses, characterized by significant structural deformities, previous surgeries, or associated functional alterations, the application of these principles remains challenging.Objective: To comprehensively analyze the technical advances of preservative rhinoplasty in complex noses, with an emphasis on anatomical fundamentals, surgical adaptations, functional outcomes, long-term stability, and revision rates.Methods: Structured narrative review of the literature, including prospective and retrospective clinical studies, case series, systematic reviews, and consensus articles published between 2008 and 2025 in the PubMed/MEDLINE, Scopus, and Web of Science databases.Outcomes related to nasal dorsum stability, respiratory function, complications, secondary rhinoplasty rates, and patient satisfaction were analyzed.Results: Preservation techniques showed a significant reduction in dorsal irregularities, a lower incidence of internal valve collapse, and better maintenance of airway patency.In complex noses, the combination of preservation principles with hybrid strategies allowed for expansion of indications, maintaining revision rates between 5% and 12%.Conclusion: Preservative rhinoplasty, when applied with strict criteria and advanced technical mastery, represents an effective strategy in the management of complex noses, offering greater structural stability and better long-term functional and aesthetic results.