Introduction <p>Since 2018, we have begun to perform preservation rhinoplasty (PR). To the best of our knowledge, very few studies have evaluated simultaneous orthognathic surgery and PR. The aim of the present study was therefore to assess the safety, efficacy, advantages, and disadvantages of PR performed at the time as OS.</p> Materials and Methods <p>A retrospective monocentric study was conducted on all patients with malocclusion who underwent OS and PR between January 2018 and December 2022 at the Face Surgery Center in Parma, Italy. Subtypes of dorsal preservation were reported according to a recent classification: type 1 (full let down), type 2 (bone scoring + full let down), type 3 (bone scoring + basal osteotomies + cartilage let down), type 4 (bone scoring + cartilage let down), type 5 (bone scoring + upper cartilage rim resection).</p> Results <p>Following the application of exclusion criteria, the final study cohort comprised 118 patients (41 males and 77 females), with a mean age of 22&#xa0;years (range 17–38&#xa0;years) at the time of surgery. The distribution of PR cases was as follows: type 1 = 29, type 2 = 34, type 3 = 27, type 4 = 16, type 5 = 12. The mean duration of the complete procedure was 207&#xa0;min, ranging from 170 to 220&#xa0;min. A total of 15 complication events (12.7%) were reported.</p> Conclusion <p>This article provides evidence that simultaneous OS and PR can be a viable option for patients with malocclusion and nasal deformity.</p> Level of Evidence IV <p>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 the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a></p>