Modification of nasal pyramid in rhinoplasty: current state of issue

Rhinoplasty is one of the most sought-after operations in aesthetic facial surgery, one of the most important parts of which is the nasal pyramid correction. Objective. To analyze and generalize data on the evolution and current state of issues of surgical correction of the nasal pyramid. Material and methods. Analysis of publications on surgical correction of the nasal pyramid (articles and related abstracts) presented in the PubMed database has been conducted. The choice of material was carried out by the following keywords: reduction rhinoplasty, structural rhinoplasty, preservation rhinoplasty, ultrasonic rhinosculpture, sculpture rhinoplasty, piezoelectric instruments, osteotomy, nasal pyramid. Results. Early concepts suggested resection, the excessive performance of which led to functional and aesthetic complications associated with the impaired stability of the nasal framework. The subsequent widespread implementation of grafts, structural elements, and preserving techniques solved the problem of cartilage framework stability, but the problem of maintaining the stability of bony vault remained unsolved. In the classical variant, changing the shape of bony vault requires a complete osteotomy, quite traumatic and not always well-controlled manipulation, which can give an unpredictable functional and aesthetic result. Conclusion. The adaptation of new technologies and their implementation into practice allowed to develop new, less traumatic and at the same time more accurate and stable approaches to rhinoplasty, which do not interfere with the function of the nose and are aesthetically effective.