Reply to: Invited Discussion on: Quality of Life and Outcome After Preservation Rhinoplasty Using the Rhinoplasty Outcome Evaluation Questionnaire

Rhinoplasty is certainly the most creative and exciting intervention in the field of plastic surgery due to the possibility of associating the technical procedures with the inventiveness and artistic sense of the surgeon. In addition, the position of the nose in the center of the face and the impact of its changes in social relationships have made this intervention the protagonist of all plastic surgery from the very beginning. Most of the publications up to the end of the 90s concerned the closed approach to rhinoplasty. And then there was a lot of discussion about the open approach and the comparison with the closed one. More recently this division into two strands has been lost due to the personalization of each surgeon. Very recently, a third philosophical approach to rhinoplasty has been added, namely “preservation rhinoplasty” which is a more conservative and much less aggressive approach. This trend translates into two techniques, the push down and the let down. The possibility of obtaining a totally smooth nasal contour after the correction of a hump, leaving this area intact, was emphasized by Saban and Ciakir and has garnered the enthusiasm of many surgeons around the world. Apart from the ongoing discussions on the indications for the push down technique and its complications, preservation rhinoplasty has the great merit of having paved the way for a less aggressive rhinoplasty and with the use of a very fine and precise dissection. The idea of my rhinoplasty, the result of daily clinical practice, is always that of a balanced and personalized rhinoplasty in which the imperfections of the nose and functional problems are corrected, but which has as its ultimate goal the maintenance of the patient's characteristics. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266.