TECHNIQUES

This leaves one with a small scar across the columella, which usually fades to be come barely visible over time. Still today, I make use of this approach in complex secondary nose-jobs (where patients have had prior rhinoplasty) Over the past 2-3 years I have been very fortunate to begin the journey of moving away from traditional open approach, reduction rhinoplasty to a new movement in rhinoplasty surgery – that of Preservation Rhinoplasty. Where possible nowadays, I will try, in suitable primary patients, to use part or all of the preservation rhinoplasty philosophy. 

Preservation rhinoplasty is a “new” philosophy in rhinoplasty, based on tissue preservation rather than resection / reconstruction which is currently the standard. It is conceptually the opposite of the septal L strut concept, in that most of the septum is preserved and manipulated, rather than being resected. The skin and soft tissue envelope is largely preserved as the plane of elevation is done at a true sub-perichondrial / sub-periostial level, using (ideally) a closed approach; although many proponents do it open too. Ligamentous structures are also preserved or if breached, are formally repaired. The dorsum is preserved where possible, with or without some manipulation, and a let- down or push- down procedure is done, hence preserving the integrity of the midvault and the keystone area, and so avoiding the need for midvault reconstruction. Osteotomies are done very accurately with either ostetomes, piezo, specifically designed micro-saws or micro-power tools. Lastly, the alars are largely preserved and manipulated using sutures. In short, there is minimal resection in the true sense of the term. Like in all of rhinoplasty, patient selection is important – this is not a procedure for all patients, but rather for a select group of primary rhinoplasty patients. Whilst the term preservation rhinoplasty is a new one, it is really a constellation of older techniques that have been refined as more of the anatomy is defined. I have been been fortunate to learn this evolving technique from colleagues abroad and am pleased to be able to offer it to selectd primary patients.

Over the past several years, increasing importance has been placed on the functional aspect of rhinoplasty – the idea being to have an aesthetic nose that functions (breathes) as well, or better than pre-operatively. As such, we often have to address the nasal septum (internal cartilage) by septoplasty, and use some of this septal cartilage to support certain structures, notably the adjusted tip . Previously somewhat neglected, this type of functional surgery is currently commonly performed as part of a modern rhinoplasty.

The surgery may take 2-4 hours – depending on what is required. Secondary surgery is more complex and takes longer.

Either way, the surgery is often done as a day case (occasionally an overnight stay is needed). A splint is placed over the nose at the completion of the surgery, and is generally worn for the first week or so.

Although some result will be seen at about a week when the cast is removed, it is important to realise and understand, that it takes about a year to 18 months before the final result can be appreciated. This time is needed for the skin envelope to contract and re-contour to the cartilage framework that was adjusted at the surgery, and the thicker one’s skin, the more protracted this process.