I don’t view preservation rhinoplasty merely as a technique for lowering the nasal bridge. For me, the key issue is determining to what extent we can preserve the nose’s ligaments, cartilage architecture, and the integrity of the nasal dorsum.
The term “preservation” is often used in conjunction with the nasal dorsum. However, the preservation of the subcutaneous ligaments, the management of the cartilages at the tip of the nose, and the continuity of the bony-cartilaginous dorsum are distinct considerations. While all of these layers may be preserved in one nose, a preservative approach may be applied only to specific areas in another.
In the article “My Approach to Preservation Rhinoplasty,” which my colleagues and I published, ligaments, cartilage structure, and dorsal anatomy are the components of this approach that are considered together. I believe it is important to evaluate each of these components separately before telling the patient the name of a single surgical procedure. [1]
The transition between the tip of the nose and the bridge of the nose involves more than just the overlying skin. Ligaments and soft tissues play a role in how the cartilages relate to one another and to the skin. Therefore, my surgical plan takes into account not only the final shape of the bone and cartilage but also how the overlying tissue will fit over this structure.
In our 2012 study on subperichondrial dissection, we addressed the management of nasal ligaments, the scroll region, and the Pitanguy ligament. This study serves as one of the foundations for the conservative approach outside the nasal dorsum. It presents our retrospective clinical experience; it is not a comparative study proving that every patient will experience less edema or faster healing. [2]
Is it possible to alter the height or position of the spine without completely removing the bone and cartilage surfaces that form it? This is the fundamental question in dorsal preservation planning. However, the answer to this question cannot be determined solely by examining the height of the arch as seen in profile. The width, curvature, surface configuration, and relationship to the septum of the spine must all be evaluated together.
The chapter “Surgical Steps in Dorsal Preservation,” which we co-authored with Erhan Coşkun, is one of the surgical education resources in this field. From the patient’s perspective, what matters is not memorizing the name of a technique, but understanding whether their own back anatomy is suitable for preservation. [3]
Achieving a smooth line in the profile is not a sufficient goal in and of itself. The support of the tip of the nose, the balance of the mid-bridge, and the condition of the nasal passage are all part of the same plan. Simply preserving an existing narrowing or curvature does not mean the problem has been solved.
For this reason, during the consultation, I listen to both the patient’s expectations regarding appearance and their breathing-related complaints. The decision to preserve a specific area makes sense only after evaluating that area’s function and its relationship with the surrounding structures. When necessary, a preservation plan is considered in conjunction with structural supports.
The terms “open” and “closed” describe the route the surgeon takes to access the nose. “Preservation,” on the other hand, refers to how the accessed tissue is managed. Structural grafts may be used in a closed procedure; principles of tissue preservation may also be applied during certain stages of an open procedure.
This distinction prevents the method from being chosen based solely on the incision. Which access route is appropriate and which structures should be preserved are two separate questions. I want the plan I recommend to the patient to provide a clear answer to both of these questions.
Significant asymmetry, severe loss of support, or a history of previous surgery may alter the goals of preservation. In such cases, the goal should not be to leave the anatomy as is simply to maintain the “preservation” designation.
I do not present preservation rhinoplasty as a guarantee of results. Suitability, expected changes, and the limitations of the procedure are evaluated on a case-by-case basis. The plan is supplemented with structural techniques as needed; the final decision is based on anatomical requirements, not on a specific name.
You can access the relevant publications and book chapters via the links below. The scope of the studies and the applicability of each technique should be evaluated on a case-by-case basis.
Barış Çakır, Bülent Genç, Valerio Finocchi, Sebastian Haack · co-authored article
Barış Çakır and colleagues · research article
Erhan Coşkun and Barış Çakır · book chapter, pp. 57–84
A treatment plan is developed by taking into account your nasal anatomy, your breathing difficulties, and your expectations.
Frequently Asked Questions About Preservation Rhinoplasty.
It cannot always be described this way. In some procedures, the position of the back is altered while preserving its surface integrity. Preserving the ligaments and structures of the tip of the nose, however, is a different matter. The surgical plan should specify which tissues will be managed and how.
No. In addition to the bridge, factors such as the width of the back of the nose, curvature, the septum, support for the tip of the nose, and previous surgeries are evaluated. Two noses that look similar in a photo may require different techniques.
The “closed approach” is a method of access; “preservation,” on the other hand, is a concept in tissue management. They can be used together, but they are not synonyms.
Yes. Protecting one area does not mean that support will not be needed in another area. Cartilage support can be planned for the tip of the nose or an area related to the nasal passages.
Following an appropriate evaluation, issues involving the septum, intranasal tissues, or the valve region can be addressed within the same treatment plan. The term “protective technique” alone does not indicate that the breathing problem will be resolved.
No such guarantee can be given. Tissue characteristics, the scope of the procedures performed, and individual differences in healing all affect the process. The reduction in swelling early on is not the same as the nose taking its final shape.
It depends on which structures were altered by the previous surgery. There may be areas that can be preserved; however, in regions where there is significant loss of support, reconstruction may be necessary.
“My Approach to Preservation Rhinoplasty,” a 2012 study addressing the management of nasal ligaments, and the chapter “Surgical Steps in Dorsal Preservation,” which we co-authored with Erhan Coşkun, are the primary sources cited on this page. The links can be found in the publications section above.
You can request an appointment to discuss your personal expectations and options.