Preservation Rhinoplasty – a ‘new’ trend?
There is much talk lately about preservation rhinoplasty. Rather than this being a new operation per se, preservation rhinoplasty is a new way of thinking about rhinoplasty. This has been discussed at length at The Rhinoplasty Society meeting in New Orleans in May 2019. It focuses on preserving structures of the tip and the bridge and modifying limited structural elements to create the result. The novel concept is that a person’s nose does not need to be changed in a dramatic way. It merely needs to be modified to make it look better. Preservation rhinoplasty on the surface sounds like it should be the answer to making rhinoplasty an easier, simpler operation. However, lets consider the anatomy and structural issues involved in preservation rhinoplasty.
Pros and Cons of Preservation Rhinoplasty
Preservation rhinoplasty was actually an early form of the operation. It was performed in the 1800’s by surgeons attempting to make the nose less projected off of the face. The surgeons removed a strip of septal cartilage and cut the bones and the boney pyramid to push the bridge down. These earlier surgeons were able to create the look of a smaller nose with this method. This allows the patient a fast recovery, very little swelling and a quicker return to their every day life. The concept to day is to preserve the ligaments and soft tissue attachments and only alter the structures necessary.
However, I see some issues with this approach. In my humble opinion, this approach to improving the look of a nose is suited for only a very small number of patients. The shapes and structures that can be controlled with this operation are limited. Thus, the changes that are going to occur are by definition limited since the concept is preservation. Also, I am very concerned about the changes of the structures that are altered OVER TIME. The surgeons that are performing this technique are doing things to the boney hump such as rasping it and then weakening it with moralizers and rongeurs (bone removing forceps and clamps). Is this a problem? We don’t know…yet. As all things in Rhinoplasty techniques, time will tell.
What should a patient do?
If your surgeon suggests a preservation rhinoplasty, (like its a branded operation or its something different), then I think it is a good idea to ask what that means. Preservation rhinoplasty is a concept, not an operation. Thus the operative plan is more of what matters. If your surgeon thinks preservation rhinoplasty is the way to go, then so be it. By the way, your surgeon suggesting this might be me one day. I have not seen the right reason to do this when my techniques, which are radically different preservation rhinoplasty, work very well. I have thousands of happy patients using techniques that I have learned, modified, and developed for my approach. Thus, adoption of a technique that is admittedly less extensive will be challenging. I believe you must give up tremendous control to perform preservation rhinoplasty and it does not solve very many problems.
So, while we watch and see what happens, I will head to the anatomy lab and see if these techniques have a place in my tool box. I will say, that it would be awesome to be able to do less and get great results. Stay tuned…for like five years!
For more information about Rhinoplasty options, please contact Dr Jay Calvert at +1.310.777.8800 or in Newport Beach, +1.949.644.2858.
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