What is Preservation Rhinoplasty?
Preservation Rhinoplasty is a buzzword over the last few years that a few astute patients and a few astute surgeons have embraced. But what does it really mean?
So, Preservation Rhinoplasty was termed by a doctor in Newport Beach california who was tired of too many patients having revisions with overly grafted noses. It is a movement against first time surgeries where rib grafting and long operative times and extensive resection and reconstruction takes place.
Is preservation rhinoplasty a single approach by a single surgeon?
No, it is more of a concept whose principles are put into three categories:
- Preservation of skin and soft tissue
- Preservation of the lower lateral cartilages
- Preservation of the upper lateral cartilages
Interestingly enough, preservation of skin does not mean open or closed but refers to the dissection plane which is subperichondrial. Most surgeons dissect above this plane and experience bleeding. There are also soft tissue structures such as muscle and ligaments which are modified in preservation rhinoplasty and resected in standard rhinoplasty.
Upper lateral cartilage preservation means that the hump is taken down from below the nose and the nose collapses into the airway. This approach has been used in the 1950’s but was determined to have inconsistent results. The main benefit of this approach is less swelling to the bridge of the nose and theoretically improved nasal dorsal lines from the front view.
Lower lateral cartilage preservation means that the lower lateral cartilages are preserved rather than resected and are reshaped. If the surgeon dissects the cartilages in the subperichondrial plane the cartilages can be reshaped with sutures oftentimes without resection.
Does Dr. Shah perform preservation rhinoplasty?
To a degree, Dr. Shah performs preservation rhinoplasty on every patient. His dissection plan is subperichondrial (He uses specialized instruments to get in this hard to reach plane). Tip cartilage is often reshaped rather than resected. For nasal dorsums, he uses preservation rhinoplasty approaches (let down , push down) techniques on select cases where the nose already has a desirable frontal view. In patients with wider frontal views or curves to the septum, preservation rhinoplasty is not the ideal approach.
What are some of the weaknesses of the approach?
Persistent nasal humps can occur with this technique. When trying to drop the nose down, it can pop back up. This phenomenon is said to occur 10% of the time but the true incidence is not known.
Is preservation rhinoplasty here to stay?
This technique is a valuable tool in the accomplished rhinoplasty surgeon tool belt and should be used on select patients for creating natural results.