Is Preservation Rhinoplasty the best rhinoplasty technique?

Rhinoplasties are among the most challenging surgeries a surgeon performs on the face. According to surveys, nearly 220,000 rhinoplasties are performed each year in the United States, making it one of the most popular procedures. Similar trends are seen in other countries. No wonder, like other popular plastic surgeries, there is immense interest in all things related to rhinoplasties. One of the latest hot topic is preservation rhinoplasty. One thing I’ve noticed is anytime there is a trendy topic, some surgeons will make claims that particular procedure is “state of the art,” “innovative,” and is the best technique. So is preservation rhinoplasty the best technique to do a nose job? The short answer is NO,

Before discussing why preservation rhinoplasty is not the best technique, we need to know what a preservation rhinoplasty. Rhinoplasties can be roughly divided into two main categories of techniques. The first-and more traditional- is what’s termed structural rhinoplasty. Dr. Jacques Joseph described this technique in the early 1900’s. Preservation rhinoplasty is not a novel new surgical technique that was invented in the past several years. In fact, this technique was first described by Drs. Goodale and Lothrop also in the early 1900’s. It was popularized first by Dr. Cottle in 1950’s. The emergence of preservation rhinoplasty popularity is another example of phrase “there is nothing new under the sun.” There have been many other “ground breaking” techniques that in reality have been around for decades.

The most common and popular rhinoplasty technique is Structural rhinoplasty. In this technique, the surgeon analyzes the nose, inspecting the functional and cosmetic elements of the nose. The goal is to produce a harmonious result. In order to achieve this goal, the surgeon may need to reduce, add, or modify various structural elements of the nose. The vast majority of rhinoplasty surgeons are trained in this technique. Open or closed rhinoplasty refers to whether the nasal skin is opened to expose underlying anatomical structures, or if the surgery is done via internal incisions (closed). Both preservation and structural rhinoplasties can be done either with open or closed approach. Another way to think about structural rhinoplasties is the nose is basically “taken apart,” and then reconstructed to improve the patient’s breathing and/or cosmetic features.

Preservation rhinoplasty, on the other hand, aims to achieve patient’s goals without taking apart the nose. Rather, this technique’s tenet is to save- ie.preserve- the native structural integrity of the nose. The key difference between the traditional structural rhinoplasty and preservation rhinoplasty is how the dorsum is managed. One of the most common reasons patients seek rhinoplasties is a nasal hump or bump. In structural rhinoplasty, this hump is carefully reduced or taken down until the desired straight dorsum is achieved. Preservation rhinoplasty keeps the dorsum intact, but lowers this dorsum by making changes to the nose below the dorsum. The idea is to remove or weaken structures underneath your hump, and then lower your hump until your profile is straight. The advantages preservation rhinoplasty offer are potential improvement in breathing because the nasal valves are more open from the lowering of the dorsum, the keystone area is not violated, more natural looking results, reduced trauma and thus faster recovery, “shorter operating time,” and “shorter learning curve.” I put the last two in quotations because I would argue the learning curve is longer because rhinoplasty surgeons are now trying to modify nasal structures in a more confined view and may struggle with exposure and angles he or she is not used to. If one is new to this technique and trying to practice, then the operating time actually may be longer than what the surgeon is used to in structural rhinoplasty. Disadvantages of this technique include a real risk of hump recurrence, your nose may look wider than you want because the nose is pushed down, and this technique is not good for complex or revision rhinoplasties.

In choosing between the two techniques, the more important factors that must be discussed are the more natural looking result, less trauma, faster recovery, and long term stability. If preservation rhinoplasty reliably produced these results over structural rhinoplasty, then I can see why one can claim preservation rhinoplasty is the better technique. However, in many things surgical, there is never one better or superior technique. Ultimately, the results come down to the skill of your surgeon. What works well for one surgeon may not work well for another. Saying preservation rhinoplasty offers more natural looking and longer lasting results is not true when humps can recur after this technique and some patients say their nose look wider after surgery. The ultimate and most important goal for rhinoplasty is patient satisfaction. It’s crucial you discuss your questions regarding preservation vs. the traditional rhinoplasty techniques with your surgeon. Just because preservation rhinoplasty is the latest trendy topic discussed on the internet and in academic meetings does not mean it is suddenly the best technique for you. So to summarize, preservation rhinoplasty is NOT the best technique. Like structural rhinoplasty, it is merely another technique that only sounds new because of sudden public interest. The better question is which surgeon you choose to do your nose job. I strongly believe the surgeon you pick is more important than whether he or she will do preservation rhinoplasty for you.

For more information about San Antonio rhinoplasty surgery, please visit our interactive website at www.dryuplasticsurgery.com. Dr. Kenneth Yu Facial Plastic and Reconstructive Surgery is a qualified team of experts serving the San Antonio, Texas area. To schedule a consultation, please contact our Concierge Patient Coordinator at (866) 574-1719 or info@dryuplasticsurgery.com.