Preservation Rhinoplasty

Preservation Rhinoplasty Sydney

Preservation rhinoplasty is a surgical technique for reshaping the nose that aims to retain as much of the patient’s original nasal structures as possible. Rather than removing and rebuilding nasal anatomy extensively, this approach focuses on repositioning and modifying existing structures. The technique has evolved considerably in recent years and continues to develop.

As with all surgery, outcomes vary between individuals and results cannot be guaranteed. Whether preservation rhinoplasty is appropriate in your case will be assessed at consultation based on your individual anatomy, functional concerns, and the changes you are seeking to discuss.

Risks of rhinoplasty surgery — please read before proceeding

How Does Preservation Rhinoplasty Differ from Other Approaches?

In traditional open structure rhinoplasty, nasal bone and cartilage are often removed, reshaped, and reconstructed using grafts. Preservation rhinoplasty instead uses techniques that reposition and modify existing structures with less removal of tissue. This means the native nasal anatomy is largely retained rather than rebuilt.

Potential considerations of the preservation approach compared to more traditional techniques include a reduced need for cartilage grafts in some patients, and a recovery period that may involve less initial swelling in some cases. However the technique is not suitable for all patients or all nasal concerns, and individual outcomes vary considerably. These differences will be discussed honestly at consultation.

Dorsal Preservation Techniques

General Principles

Dorsal preservation refers to techniques that address the bridge of the nose by lowering or modifying the underlying structures without complete removal of the dorsal profile. Specific approaches include:

Subperichondrial and subperiosteal dissection — precise tissue plane techniques that preserve soft tissue attachments to cartilage and bone
Cartilage repositioning rather than removal, where anatomy permits

Let Down and Push Down Techniques

The let down technique involves lowering the nasal dorsum by making controlled cuts (osteotomies) at the nasal sidewalls and base of the bony pyramid, allowing the dorsal segment to settle without removing the dorsal prominence. The push down technique is similar but involves pushing the entire nasal dorsum downward after making space beneath it. Which technique, if either, is appropriate depends on individual anatomy and will be assessed at consultation.

Spreader Grafts and Spreader Flaps

Spreader grafts involve placing cartilage grafts between the septum and upper lateral cartilages to support the internal nasal valve and maintain the dorsal contour. Spreader flaps create similar support using the patient’s own upper lateral cartilage folded and sutured to the septum. Both approaches aim to maintain nasal structure and airflow.

High Strip and Low Strip Techniques

These techniques involve strategic resection of cartilage from specific portions of the septum to allow repositioning while maintaining the dorsal contour. The appropriate approach depends on individual septal anatomy.

Tip Preservation Techniques

Various techniques exist for addressing the nasal tip while preserving existing cartilage structures, including the cephalic fold-in technique (folding rather than trimming the upper portion of the lower lateral cartilages), preservation of the Pitanguy ligament (a key support structure of the nasal tip), and the use of the patient’s own preserved cartilage for tip support where grafting is required.

Alar Base and Septal Techniques

Alar base suture techniques modify the shape and position of the alar base using sutures rather than extensive resection. Alar batten grafts may be placed to support the nasal sidewalls. Septal preservation techniques include the swinging door technique (mobilising the septum at a controlled hinge point for repositioning) and, where required, extracorporeal septoplasty (temporarily removing the septum for reshaping before reinsertion).

Osteotomy Techniques

Where bone cuts are required as part of a preservation rhinoplasty, piezoelectric (ultrasonic) instruments may be used to perform precise osteotomies with reduced trauma to surrounding soft tissues. Smaller, more controlled osteotomies (micro-osteotomies) may also be used to reposition nasal bones while retaining as much original structure as possible.

Risks and Recovery

All surgery carries risk. Full information about the risks of rhinoplasty surgery is available at the link below and patients are strongly encouraged to read this before proceeding. Recovery from preservation rhinoplasty varies between individuals. Swelling is expected following surgery and resolves gradually over many months — subtle swelling, particularly at the nasal tip, can persist for twelve months or longer. Realistic expectations regarding your individual recovery will be discussed at consultation.

Risks of rhinoplasty surgery