Preservation vs open structure rhinoplasty

Preservation Rhinoplasty

Philosophy:

• Focuses on preserving as much of the patient’s natural nasal anatomy as possible.
• Aims to maintain the integrity of the nasal structures, such as bone and cartilage, rather than removing and reconstructing them extensively.

Techniques:

• Dorsal Preservation: Techniques like push-down or let-down procedures that adjust the height of the nasal dorsum without removing the nasal hump.
• Intermediate and High/Low Dorsal Strip: Techniques where strategic portions of cartilage and bone are preserved to maintain natural contours.
• Minimal Resection: Emphasises repositioning and reshaping existing structures rather than extensive excision.
• Subperichondrial and Subperiosteal Dissection: Precise dissection under the cartilage and bone coverings to minimize tissue disruption.

Advantages:

• More natural-looking results due to the preservation of natural nasal lines and contours.
• Typically less invasive, leading to reduced swelling, bruising, and faster recovery.
• Maintains structural support and function, reducing the risk of postoperative breathing difficulties.
• Less need for grafts and extensive reconstruction.

Ideal Candidates:

• Patients seeking subtle refinements rather than dramatic changes.
• Those with good existing nasal structure who want to maintain their natural nasal anatomy.

Open Structure Rhinoplasty

Philosophy:

• Allows for extensive modification and reconstruction of the nasal anatomy.
• Provides maximum visibility and access to the nasal structures, enabling precise and comprehensive reshaping.

Techniques:

• Open Approach: Involves an external incision across the columella (the tissue between the nostrils) to lift the nasal skin and fully expose the underlying structures.
• Extensive Resection and Reconstruction: Bone and cartilage are often extensively removed, reshaped, and reconstructed to achieve the desired nasal shape.
• Grafts and Implants: Commonly uses cartilage grafts (from the septum, ear, or rib) to support and shape the nose.
• Precise Modification: Allows for detailed adjustments to the nasal tip, bridge, and other areas.

Advantages:

• Provides the surgeon with a clear and unobstructed view of the nasal anatomy, facilitating precise modifications.
• Suitable for complex cases requiring significant structural changes or reconstruction.
• Can address a wide range of aesthetic and functional issues.

Ideal Candidates:

• Patients requiring extensive nasal reshaping or correction of complex deformities.
• Those who have had previous rhinoplasty surgeries and need revision.
• Individuals with significant functional issues, such as severe breathing difficulties or structural defects.

Summary of Differences:

1. Philosophy and Approach:
   • Preservation Rhinoplasty: Emphasises conserving natural structures and making subtle adjustments.
   • Open Structure Rhinoplasty: Focuses on comprehensive access and extensive reshaping or reconstruction.
2. Techniques:
   • Preservation Rhinoplasty: Involves minimal resection and strategic preservation of cartilage and bone.
   • Open Structure Rhinoplasty: Uses an open approach with potential for significant resection and reconstruction, often involving grafts.
3. Recovery and Outcomes:
   • Preservation Rhinoplasty: Generally results in less swelling, bruising, and a quicker recovery.
   • Open Structure Rhinoplasty: May involve a longer recovery period due to more extensive surgical modifications.
4. Ideal Candidates:
   • Preservation Rhinoplasty: Best for patients seeking natural results with minimal changes.
   • Open Structure Rhinoplasty: Suitable for those needing significant aesthetic or functional corrections.

Both techniques have their unique benefits and are chosen based on the individual patient’s needs, goals, and the complexity of the nasal issues being addressed.