Preservation rhinoplasty - what is it exactly?
So called structural-preservation rhinoplasty is a term that connects two approaches in rhinoplasty technique:
- structural rhinoplasty and
- preservation rhinoplasty
in an effort to achieve additional advantages with a safer outcome, improved aesthetics and reduction of complications.
With this technique, the need for more difficult nasal reconstructions and dorsal camouflage has decreased in primary rhinoplasty. This offers possibility to take more cartilage for other uses such as septal extension grafts, nasal alar margins, or strut grafts of the lateral alar cartilages.
Advantages of dorsal preservation over the classic method include the following:
- preserving the favorable attributes of the nose in the frontal projection
- reduced need for cartilage grafts
- faster healing of the upper two-thirds of the nose.
Concept of preservation rhinoplasty
This technique aims to preserve the stability of the nose and help structure the nasal tip and dorsum with grafts in order to strengthen the contour and support of the nose. The concept of dorsal preservation is the achievement of favorable dorsal aesthetic lines without creating the so-called “open roof”.
The ideal candidate has anatomy accessible to modeling with the help of minimally invasive instruments such as piezo osteotomes or microdrills (power assisted instruments).
Suitable candidates
The shape of the bony-cartilaginous hump on the nose (convexity) is important in choosing the optimal candidate for preservation rhinoplasty. So called V shape of the dorsal hump has a rectilinear configuration from the nasion to the rhinion, while the S-shaped hump deformity has a pronounced angulation in the upper part (nazion) and minimal curvature in the lower part.
V-shaped hump is ideal for dorsal preservation, while S-shaped hump may require surface modification to allow for adequate flattening. For this purpose, the use of piezoelectric rhinosculpture and vault-preserving techniques for anatomy such as an S-shaped nose, wide or asymmetrical nasal bones, or a low nasal root was conceived.
One of the most important advantages of preservation rhinoplasty is the reduced need for ear cartilage or fascia removal in primary rhinoplasty.
Surgical techniques
Some elements of the so-called preservation rhinoplasty. Individual steps can be performed with typical instruments or with the help of a piezotome (ultrasonic osteotome).
