Preservation rhinoplasty is an approach that aims to keep the natural bone and cartilage of the nasal bridge intact, lowering a hump by removing a strip of tissue beneath or at the base of the bridge rather than shaving its surface. It contrasts with structural rhinoplasty, where the hump is removed and the bridge rebuilt. Preservation techniques can suit some noses with a straightforward hump, while structural methods remain better for crooked, damaged or previously operated noses.
The idea behind preservation
In a traditional hump reduction, the surgeon rasps bone and trims cartilage from the top of the bridge. This leaves an ‘open roof’, which is closed by moving the nasal bones inwards, and the middle part of the nose is often reinforced with spreader grafts to keep the airway open and the bridge smooth. Preservation rhinoplasty takes a different route. The upper surface of the bridge is left as it is, and the whole bridge is lowered, a little like lowering a roof by shortening the walls beneath it. Because the natural ridge is kept, the bridge lines can look smooth and continuous.
Key preservation techniques
- Dorsal preservation (push-down or let-down): strips of bone at the sides and base of the nasal pyramid are removed so it can be lowered as a single unit, with a strip of septum taken out beneath to make room.
- Septal strip techniques: a section of septum is removed high or low beneath the bridge to allow the dorsum to drop.
- Tip preservation: reshaping the tip cartilages mainly with sutures, keeping as much of the natural cartilage as possible.
- Soft tissue preservation: lifting the skin in a deeper plane close to the bone and cartilage, intended to reduce swelling and protect the skin envelope.
Side-by-side comparison
- Hump reduction: preservation: the bridge is lowered intact. Structural: the hump is removed and the bridge reconstructed.
- Bridge surface: preservation: natural ridge kept. Structural: new surface created, sometimes with grafts.
- Best suited to: preservation: straight, moderate humps in a first operation. Structural: crooked noses, large humps, wide middle vaults, weak cartilage and revision cases.
- Grafts: preservation: often fewer. Structural: commonly uses spreader and tip grafts, usually from septum.
- Specific risks: preservation: a residual or recurrent small hump. Structural: irregularities of the rebuilt bridge or an inverted V deformity if support is inadequate.
- Approach: both can be performed open or closed, depending on the tip work needed.
Who might suit preservation
Preservation techniques tend to be considered for a first rhinoplasty in a nose with a moderate, fairly straight hump, a reasonably straight septum and good-quality skin. They are less suitable for a very large hump, a significantly crooked nose, a wide bridge that needs narrowing substantially, a saddle nose or a nose that has had previous surgery. In practice, many surgeons combine elements of both philosophies, for example preserving the tip cartilages while using a structural approach for the bridge.
Recovery and results
Recovery after preservation rhinoplasty is broadly similar to other rhinoplasty: a splint for about a week, bruising around the eyes over roughly two weeks, and gradual settling of swelling for a year or more. Some surgeons report less swelling with deeper soft-tissue dissection, but individual healing varies and no approach avoids swelling entirely. A recognised issue is the return of a slight hump, which may need minor revision. The final judgement should be made once healing is complete.
Which is right for you?
The best technique depends on your anatomy and goals rather than the label. If you have a straight, moderate hump and want to keep a natural-looking bridge, preservation methods may be worth discussing. If your nose is crooked, very wide, damaged or previously operated on, a structural approach usually offers more control. Mr Nassab will examine your nose, explain which techniques he recommends and why, and discuss the potential benefits and limitations of each. Read more on the rhinoplasty page and in the guide to the nose bridge.
Cost
Rhinoplasty costs from £8,950 whichever technique is used, and complex or revision surgery is quoted at consultation. The £150 consultation fee is separate. Surgery is for adults aged 18 and over.
Frequently Asked Questions
Is preservation rhinoplasty better than traditional rhinoplasty?
Neither is better for everyone. Preservation suits some noses with a straightforward hump, while structural methods offer more control for complex cases.
Can preservation rhinoplasty be used for revision?
It is generally less suitable for revision, because the original bridge structure has usually been altered.
Does preservation rhinoplasty reduce swelling?
Some surgeons find deeper dissection limits swelling, but healing varies and swelling still takes months to settle.
Can the hump come back after preservation rhinoplasty?
A small residual or recurrent hump is a recognised possibility and may occasionally need a minor revision.
