Open Structural & Preservation Rhinoplasty is an open rhinoplasty approach that combines the principles of Structural Rhinoplasty and Preservation Rhinoplasty. It aims to modify nasal structures where necessary while preserving as much of the suitable native anatomy as possible. Treatment is planned according to each individual's nasal anatomy and facial proportions.
This approach does not aim to completely dismantle and reconstruct every part of the nose. Instead, it emphasizes identifying which structures should be preserved, which should be modified, and which require additional support so that the external nasal shape is consistent with its underlying structural framework.
At Dr. Gorn Aesthetique, physicians evaluate the nasal dorsum, bones, cartilage, septum, nasal tip, nasal base, skin, and the relationship between the nose and facial features before selecting an appropriate surgical technique for each individual.
What Is Open Structural & Preservation Rhinoplasty?
This approach combines three key principles:
- Open Rhinoplasty – Provides surgical access to the internal nasal structures, allowing the surgeon to directly visualize the anatomy and make precise structural adjustments.
- Structural Rhinoplasty – Modifies or reinforces the nasal support system in areas requiring additional strength or greater control over nasal shape.
- Preservation Rhinoplasty – Preserves suitable existing bone, cartilage, tissues, and supporting structures while avoiding unnecessary anatomical changes.
Rather than choosing between Structural and Preservation Rhinoplasty, both principles can be applied to different parts of the same nose when appropriate.
What Is Preservation Rhinoplasty?
Preservation Rhinoplasty is a surgical philosophy that emphasizes maintaining existing nasal anatomy where the structures and shape are already suitable.
Instead of removing or reconstructing every structure, the surgeon evaluates which components can be retained and modifies only those that require correction.
Structures that may be considered for preservation include:
- Selected portions of the nasal dorsum
- Nasal tip cartilage
- Supporting tissues and ligaments
- The nasal tip support system
- Cartilage and soft tissues with suitable structural quality
However, preservation does not mean that no structures can be cut, modified, or reconstructed. It means avoiding changes to anatomical structures that do not require correction.
What Is the Role of Structural Rhinoplasty?
Although preserving existing anatomy may be desirable, some nasal structures may lack sufficient strength or have shapes that require correction.
Structural Rhinoplasty addresses these concerns by modifying or reconstructing the nasal support system. This may involve:
- Strengthening nasal tip support
- Repositioning cartilage
- Correcting structural asymmetry
- Adjusting tip projection
- Adjusting tip rotation
- Providing additional structural support where necessary
- Reconstructing areas where the existing anatomy is insufficient
The goal is to provide the necessary structural strength without adding more support or reconstruction than the individual nose requires.
Why Combine Structural and Preservation Rhinoplasty?
A single nose may contain both structures that are already suitable and structures that require correction.
For example, certain portions of the nasal dorsum may have an appropriate shape and can be preserved, while the nasal tip may lack sufficient structural support or have asymmetry that requires adjustment.
Open Structural & Preservation Rhinoplasty therefore allows the surgeon to select different approaches for individual areas of the nose, including:
- Preserving suitable existing structures
- Minimizing unnecessary tissue disruption
- Modifying only the areas requiring correction
- Reinforcing structures where additional support is needed
- Designing the nasal dorsum and tip to complement each other
- Maintaining appropriate characteristics of the original nose
Why Use an Open Approach?
Open Rhinoplasty involves incisions inside the nostrils together with a small incision across the columella, allowing the surgeon to expose and directly visualize the internal nasal structures.
This approach allows detailed assessment of cartilage symmetry, nasal tip anatomy, the septum, and the various supporting structures.
Using an open approach does not mean that every structure must be modified. Direct visualization of the anatomy can be combined with preservation principles to address only the areas requiring correction.
Preservation Does Not Mean Leaving Every Structure Untouched
A common misconception is that Preservation Rhinoplasty means avoiding all cutting or modification of nasal structures. This is not entirely accurate.
The guiding principle is Preserve What Should Be Preserved – Modify What Needs to Be Modified.
If a particular structure is suitable, the surgeon may preserve it. However, if another structure is abnormal or lacks adequate strength, structural techniques may be used to correct it.
Therefore, the extent of preservation and structural modification varies from patient to patient.
Personalized Rhinoplasty Based on Individual Anatomy
Before surgery, the physician evaluates the nasal and facial structures together, including:
- Nasal bridge height and width
- Nasal dorsum shape
- Nasal length
- Strength of the nasal tip cartilage
- Tip projection
- Tip rotation
- Nasal base and alar shape
- Skin thickness and elasticity
- Nasal symmetry and alignment
- Septal structure
- The relationship between the forehead, nose, lips, and chin
These findings help determine which structures can be preserved and which require structural modification.
Who May Be Suitable for Open Structural & Preservation Rhinoplasty?
Individuals with the following concerns may consider a surgical assessment:
- A desire to refine the nose while preserving suitable existing structures
- Existing nasal structures that are already suitable and do not require complete alteration
- A desire to refine the nasal tip or improve structural support
- A nasal tip with insufficient definition or support
- Nasal asymmetry
- Certain types of dorsal humps or dorsal contour irregularities
- A desire to improve the relationship between the nasal dorsum and tip
- A preference for nasal design based on individual anatomy rather than a predetermined nose shape
Suitability for preservation techniques depends on the actual nasal anatomy. Not every patient can preserve the same extent of existing structures.
Does Open Structural & Preservation Rhinoplasty Require Cartilage Grafts?
Additional cartilage grafts may or may not be required, depending on the structural support needed.
If structural reinforcement is necessary, the surgeon may consider autologous cartilage, or cartilage harvested from the patient's own body, such as:
- Septal Cartilage – Cartilage from the nasal septum
- Ear Cartilage – Cartilage from the ear
- Rib Cartilage – Cartilage from the rib
The choice of cartilage source depends on the amount, strength, and function required for the planned reconstruction. Rib cartilage is not necessary in every case.
Does Preservation Rhinoplasty Produce More Natural-Looking Results?
A natural-looking result does not depend solely on the name of the surgical technique. It also depends on surgical design, the original nasal shape, anatomy, skin thickness, and the appropriate degree of modification.
The preservation approach aims to maintain suitable existing structures, which may help retain distinctive nasal characteristics. However, this does not guarantee the same results for every patient.
Designing nasal proportions that complement the face therefore remains a key consideration.
How Is Open Structural & Preservation Rhinoplasty Different from Structural Rhinoplasty?
Structural Rhinoplasty emphasizes modifying and reconstructing the nasal support system to control shape and structural strength.
Structural & Preservation Rhinoplasty additionally emphasizes maintaining suitable existing anatomy and applying structural modifications only where necessary.
In simple terms, the approach does not begin solely with the question "What additional structures should we build?" It also asks "What should we preserve, and what needs to be corrected?"
Can This Approach Be Used for Revision Rhinoplasty?
Individuals who have previously undergone rhinoplasty may be considered for assessment, although the extent of preservation may differ from that of primary rhinoplasty.
Previously operated noses may contain scar tissue, cartilage that has been removed or repositioned, and anatomical structures that have already been modified.
The surgeon must therefore evaluate which structures can still be preserved and which require reconstruction or further correction.
How Long Is Recovery After Open Structural & Preservation Rhinoplasty?
After surgery, temporary swelling, bruising, tightness, or nasal congestion may occur during the early recovery period. The severity of these symptoms depends on the extent of the procedure.
Although preservation principles are incorporated, this remains a surgical rhinoplasty procedure. Recovery depends on the actual extent of bone, cartilage, and soft tissue modification in each individual.
The nasal tip may take longer to settle than other areas, and nasal contours can continue to change as swelling subsides and the tissues heal.
