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Preservation rhinoplasty is a surgery that reshapes the nose while preserving its original structure. Many see this technique as the future of nasal surgery.
Dr Chris Snijman, a leading plastic and reconstructive surgeon at Mediclinic Morningside, explains how it works.
Changes in rhinoplasty surgery
“Fundamentally, the way we approach nose surgery, especially rhinoplasty, has really changed,” says Dr Snijman. He explains that major shifts in rhinoplasty techniques happen every few decades, often due to important studies. In the 1970s and 1980s, open structural rhinoplasty became more popular. Before that, surgeries involved making small cuts and removing bone and cartilage. The new approach focused on opening the nose up, taking out parts, and using cartilage grafts to support the structure.
“The next generational epoch started in around 2018 with what we call preservation rhinoplasty,” Dr Snijman continues. “This means we don’t remove anything out of the nose. We’re preserving and repositioning the existing anatomy inside the nose.”
Although some methods for preserving the nose were first mentioned over a century ago, they didn’t catch on because there wasn’t enough skill, understanding, or proper tools at the time, says Dr Snijman. But over the past six years, preservation rhinoplasty has become more popular because of skilled surgeons, better insight into nasal anatomy, and improved surgical tools. “We have a much better understanding of the anatomy, of what can and needs to be preserved and what needs to be repositioned,” he says.
Understanding preservation rhinoplasty
Complete preservation rhinoplasty consists of three main components, according to Dr Snijman:
- Dorsal preservation: Focuses on the bony part of the nose, specifically the bridge.
- Soft tissue preservation: Involves maintaining the integrity of the skin and soft tissue covering the nose, as well as the underlying support structures.
- Cartilage adjustment: Refers to modifying the cartilage structures at the tip of the nose.
Partial preservation happens when surgeons only address one or two of the above areas.
In rare cases where preservation isn’t possible, doctors might use rib cartilage for reconstruction. Dr Snijman prefers to avoid this if he can. He explains, “If there isn't enough cartilage from the septum inside the nose, then we must use rib cartilage. But this adds extra structure, which can lead to issues like warping or becoming visible over time. Plus, taking rib cartilage carries risks and can make recovery more difficult for the patient.”
Team approach
“There aren’t many surgeons who do rhinoplasty regularly, and even fewer use preservation techniques. I have one of the largest collection of cases in the country, and I truly believe this is the future of nose surgery,” says Dr Snijman. He recently shared his findings at the Joint APRASSA and ISAPS Congress on Facial Aesthetics in Cape Town.
“It’s very rare these days to do a purely cosmetic nose job, there’s always a functional component that needs to be addressed,” he explains. At Mediclinic Morningside, Dr Snijman and three ear, nose, and throat surgeons work closely together. “We take a holistic approach, focusing on both form and function. Our priority is improving the patient’s breathing, which often leads to aesthetic improvements as well.
“Any doctor training in nose surgery needs a strong background in structural and reconstructive techniques before they can move on to preservation methods.” This type of surgery requires special skills and slightly different tools.
“The days of the hammer and chisel are over. We use piezoelectric technology, very fine saws and scrapers that allow us to do much more precise work on the bone with a stable and predictable long-term result.”
Ideal candidates
As doctors become increasingly skilled in this surgery and the different mindset it requires, preservation rhinoplasty can be suitable for most nasal surgery patients, Dr Snijman explains. However, there are still ideal candidates for this procedure.
“Ideal candidates have a minor dorsal hump – relatively straight noses with minimal septal deviation, and relatively short nasal bones,” he says. As the skillset expands and knowledge base grows, preservation principles can be applied to almost any nose. The only patients who aren’t suitable candidates are those who have previously undergone open structural procedures, as there is typically nothing left to preserve.
Benefits of preservation rhinoplasty
Preservation rhinoplasty has many advantages for patients compared to traditional open rhinoplasty. “The procedure is faster and more precise, causing less damage to the soft tissues and bones, and there’s much less bleeding and swelling afterward,” says Dr Snijman. Patients also have a shorter recovery time and can look socially presentable within seven to ten days. “There’s a much better improvement in function, quicker recovery and a much more stable result in the long term.”
Although revision rates for nasal surgery remain between 8-12%, even among the most skilled surgeons, revision surgeries for preservation cases generally require much less reconstruction than earlier methods. “In 99% of cases you don't require rib cartilage to address the problem,” he adds.