The Ballerina Maneuver: A Lateral Keystone Release Technique in Preservation Rhinoplasty

Introduction Preservation rhinoplasty aims to maintain the natural dorsal aesthetic lines while reducing dorsal height and achieving a harmonious dorsal contour. Creating a refined dorsal concavity may be challenging, particularly in patients with low to moderate humps who desire a more elegant dorsal profile while preserving the structural integrity of the native dorsum. The Ballerina maneuver was developed as a surgical refinement designed to enhance dorsal concavity within the principles of dorsal preservation rhinoplasty. Objectives & Hypotheses The aim of this study was to describe the Ballerina maneuver and illustrate its role in refining dorsal contour in preservation rhinoplasty. We hypothesized that this maneuver would allow controlled enhancement of dorsal concavity while maintaining dorsal stability and supporting harmonious dorsal aesthetics. Study Design Technical description of a surgical maneuver. Methods The Ballerina maneuver was performed as an adjunctive step during preservation rhinoplasty in selected patients seeking a more concave dorsal profile. The technique focused on controlled modification of the middle vault structures while preserving the continuity of the native dorsum. The surgical concept, technical steps, and key considerations were described to facilitate safe and reproducible application. Representative clinical cases were presented to illustrate the surgical application of the maneuver and its role in dorsal contour refinement. Conclusion The Ballerina maneuver represents a reproducible adjunctive technique for refining dorsal contour in preservation rhinoplasty. By enabling controlled enhancement of dorsal concavity while maintaining the integrity of the native dorsal framework, the maneuver supports the core principles of structural preservation and may expand the surgical armamentarium for achieving precise and natural dorsal aesthetic refinement.