What is Preservation Rhinoplasty?

Preservation rhinoplasty is in the news. But is preservation rhinoplasty news or indeed is it new at all? In fact, preservation rhinoplasty is a catch phrase which was introduced by rhinoplastic surgeons in 2018. The concept of preservation rhinoplasty was to introduce a more conservative treatment of nose reshaping surgery and to try and minimize the trauma of surgical rhinoplasty, especially in the removal of the hump or bump on the bridge of the nose known as the dorsal hump. Traditionally in rhinoplasty surgery, a chisel is used to remove the dorsal hump. In preservation rhinoplasty the hump is “pushed down” or “let down” in order to establish a smoother shape and better profile.  In fact, this technique is not entirely new but is a rebirth of a technique introduced in the 1970s and ’80s. One of the most prolific proponents of this earlier technique was Dr Jean Kern, consultant rhinoplastic surgeon at the prestigious Mayo Clinic in Rochester, Minnesota in the USA. Dr Hodgkinson had the privilege of training in plastic surgery and rhinoplasty surgery at the Mayo Clinic and working with Dr Kern during the period in which he developed these techniques.

Nasal Tip Rhinoplasty
Nasal Tip Rhinoplasty by Dr Hodgkinson
Before & After Nasal Tip Rhinoplasty by Dr Hodgkinson

“Preservation” in the term preservation rhinoplasty can refer to more than preservation of the bone of the dorsal hump, it can also refer to preservation of the cartilages in the nasal tip. In fact, it is the nasal tip which presents the greatest challenge to the surgeon. Formerly, it was not uncommon to resect or remove part of the cartilages in the nasal tip. Nowadays, the practice referred to under the term preservation rhinoplasty is to reshape and resuture the cartilages to give them a more pleasing and predictable shape. This more predictable shape then translates onto the skin and its ability to assume this new shape as it is redraped. This work on the cartilage of the nasal tip is usually performed as an open rhinoplasty granting better access to these structures.

Other techniques which can be used to shape the nasal tip include grafting. Grafting techniques for nasal tip rhinoplasty are especially useful when the tip of the nose is droopy. This surgical restructuring of the nasal tip allows for a more sophisticated and harmonious result. By creating a deeper plane of dissection on the nasal tip cartilages and preserving and reconstituting the tiny ligaments that connect the cartilage to the skin, each other and to the adjacent bones, the surgeon aims to retain the structure and reduce the amount of swelling that can occur after the surgery.  Many patients are rightfully fearful that the nose will lose its structure, become too high, and be a ‘piggy’ nose. Structure should be maintained to prevent this.

Component & Finesse Rhinoplasty
finesse rhinoplasty dr darryl hodgkinson
Before & After Finesse Rhinoplasty by Dr Hodgkinson

Since the 1980s preservation rhinoplasty is not the only term facial plastic surgeons have employed to describe their techniques and results. Many other terms have also been used to describe various rhinoplasty techniques. Other terms you may come across include: “component rhinoplasty” and “finesse rhinoplasty”. These terms describe more complex surgical procedures. For a surgeon to carry out component rhinoplasty or finesse rhinoplasty they must have a high level both academic and practical anatomical understanding of the complex internal anatomy of the nasal structures including all the elements: bone, cartilage and ligaments.  These more complicated surgical procedures have also given rise to more sophisticated surgical instrumentation. Whilst chisels and rasps are still a critical part of the rhinoplastic surgeon’s armamentaria, the “tool kit” now includes high tech items such as fibreoptic instrumentation, power tools and ultrasonic Piezo instrumentation.

Breathing Must be Assessed Before Rhinoplasty
Before & After Septorhinoplasty by Dr Hodgkinson to Improve Breathing
Before & After Septorhinoplasty by Dr Hodgkinson to Improve Breathing

 Many patients do not realise that any issues of breathing can and indeed should be addressed at the same time that any aesthetic rhinoplasty is carried out.  It is routine now and indeed responsible for plastic surgeons to assess the need for improved breathing as an integral part of any nose surgery.  Plastic surgeons now evaluate the patients breathing and nasal function of their airways at consultation using rhinomanometry. Other diagnostic tools used to assess a patient’s breathing capacity may include CAT scan preoperatively to evaluate the total airway from the tip of the nose to the pharynx.

Dr Hodgkinson & Rhinoplasty

Rhinoplasty is regarded as one of the most demanding and challenging operations in all aesthetic facial plastic surgery. Aesthetic and functional rhinoplasty including preservation rhinoplasty, component rhinoplasty and finesse rhinoplasty as well as other noses surgery procedures have all been a mainstay of Dr Hodgkinson’s surgical practice.

Early in his career, Dr Hodgkinson in addition to his time at the Mayo Clinic had the remarkable opportunity of spending a six-month fellowship in aesthetic plastic surgery in Newport Beach, California. It was in California that he was introduced to and exposed to the work of one of the great founding fathers of rhinoplasty, Dr Jack Sheen in Los Angeles. Dr Sheen is credited as the father of modern rhinoplasty and acknowledged as the surgeon who laid down the aesthetic tenets of modern rhinoplasty.  Interestingly, Dr Sheen’s procedures were all carried out using the closed technique.  Dr Hodgkinson mastered the closed technique but was among a number of plastic surgeons to realise that there were limitations to what could be achieved with closed rhinoplasty especially in relationship to adjustment of the nasal tip and secondary or revision rhinoplasty.

Open Rhinoplasty
Before & After Open Rhinoplasty by Dr Hodgkinson
Before & After Open Rhinoplasty by Dr Hodgkinson

The delicate cartilages of the nasal tip, which are shaped like and have the consistency of the cereal “cornflakes”, require exposure to be appropriate dealt with.  This exposure is achieved by opening up the skin at the tip of the nose so the cartilages could be accurately stitched together and reshaped known as “open rhinoplasty”.  To “open the nose”, a small imperceptible scar is placed in the columella. Open structural rhinoplasty is particularly necessary in the repair of the cleft lip nose and in secondary rhinoplasty. Preservation rhinoplasty can be either open or closed depending on the aesthetic areas of the nose which need to be addressed and the underlying structure which needs to be modified.

 

Dr Hodgkinson has performed well over 4,000 rhinoplasties in his extensive career and has always maintained a passion for rhinoplasty surgery as it creates such a profound change in the appearance of the patient’s face. He has published multiple scientific articles on various aspects of rhinoplasty and has lectured internationally in over 30 congresses on challenging rhinoplasty cases. Dr Hodgkinson has also had an interest in the psychosocial motivation of patients seeking rhinoplasty.

If you are interested in learning more about rhinoplasty, you should consider an in-person consultation with Dr Hodgkinson and his team.  During your consultation, you can discuss your aesthetic desires, have computer imaging to see what might be possible for you and have a breathing assessment. Call the clinic today on 02 9362 7400 to make an appointment or email us at [email protected] You may also be interested in getting a copy of our info pack on rhinoplasty.

 

 

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