Background. - Preservation rhinoplasty resulted in a major change in the philosophy of rhinoplasty surgery, it include 3 main elements: elevation of a sleeve of skin from the subperichondrial-subperiosteal plane, preservation of the osseo-cartilaginous dorsum, and maintaining the alar cartilages with minimum excision while achieving the desired shape using sutures. Patients and methods. - This is prospective study included 113 patients who underwent dorsal preservation rhinoplasty for nasal hump treatment. Patients were followed for 15 months after surgery. Aim of study. - To compare the different outcomes between V-shaped and S-shaped dorsum regarding the cosmetic and functional outcomes after preservation rhinoplasty. Results. - The mean age of our patients was 27.19 years, females constituted 61.1%. Most patients (77.9%) had no complications after surgery, residual hump was the commonest in 13.3% of the patients, other complications were dorsal indentation in 5.3%, bleeding in 2.7%, and granuloma at the dorsal osteotomy site in 0.9% of patients. About 75.22% had S-shaped deformity, and the rest 24.78% had V-shaped deformity. The correlation was not significant between the types of the nasal hump deformity and the gender (P-value 0.395), age of patients (P-value 0.064), the overall postoperative SCHNOS for obstructive symptoms (P-value 0.19), the overall postoperative SCHNOS for aesthetic outcome (P-value 0.33), the postoperative complications (P-value 0.531), and the type of complications (0.705), while it was very significant with different postoperative SCHNOS scores for obstructive symptoms (P-value 0.000), postoperative SCHNOS different aesthetic scores (P-value 0.001), operation time and lowering the dorsal hump (P-values 0.000) for both. Conclusion. - Preservation rhinoplasty has low risk for postoperative complications. V-shaped deformity has a better overall outcome than S-shaped one. (C) 2022 The Authors. Published by Elsevier Masson SAS.