I do not describe my experience in rhinoplasty as a linear path in which I transitioned from reconstructive surgery to preservation surgery, leaving one behind. The real issue is which of the two approaches’ tools we will use to address a given anatomical problem.
The question “Structural or preservation?” can serve as a starting point; however, it does not, by itself, determine the surgical plan. The nasal bridge, nasal tip, and airway may not all be equally suitable for preservation. While preserving a strong existing structure in one area, it may be necessary to re-establish inadequate support in another area.
In the article “Trial, Error, and Expertise,” which we published with Erhan Coşkun, we discussed our experience with structural and preservation techniques within this context of development. The publication is a retrospective evaluation of our personal surgical experience; it is not a randomized comparison demonstrating that one approach is superior in all patients. [1]
By this heading, I do not mean to perform the same procedure on every patient. First, I determine which tissue is valuable in terms of its form and function, and then I determine which relationship needs to be altered. The decision to preserve and the decision to restructure are both the result of the same analysis.
The book *Structural Preservation Rhinoplasty*, of which I am a co-editor, addresses this field with contributions from numerous surgeons. I would like to emphasize that the title and approach represent a shared body of knowledge. The convergence of diverse surgical experiences within a single resource facilitates a joint discussion of patient selection and the transition between different techniques. [2]
When discussing the preservation of the nasal bridge, the bridge’s current shape must also be taken into account. A nasal bridge with issues such as width or asymmetry may not achieve the desired shape simply by reducing its height. The goal of preservation does not eliminate these issues.
The article “Hybrid Dorsal Preservation Rhinoplasty,” of which I am a co-author, discusses an approach that reorganizes specific features of the nasal dorsum while preserving the connections in the bone-cartilage junction—referred to as the “keystone.” This publication serves as a concrete example of the integration of preservation and structural reorganization within the same framework. [3]
With a large, wide, or noticeably curved nose, the issue is not simply a matter of correcting a single line. The direction of the bridge, the position of the central structures, and the balance of the lateral walls are all considered together. These characteristics can push the boundaries of a classic reconstruction plan.
The article “Libra Flap / Central Platform Surgery,” which my colleagues and I published, presents a series of techniques targeting this decision-making area in large and deviated noses. The study reports on a retrospective experience involving 77 patients. It should not be concluded that the same technique can be applied to every deviated nose or every revision procedure. [4]
In one patient, it may be appropriate to preserve the continuity of the dorsum and provide support for the tip of the nose. In another patient, a specific portion of the dorsum may be reconstructed while utilizing the existing cartilage of the tip. The internal consistency of the plan is more important than the instruments used bearing the same label.
This is what needs to be explained to the patient: Which part will be preserved, which part will be altered, and what is the rationale behind this decision? The significance of the technical details becomes clear when they are related to the patient’s anatomy and expectations.
Just because a surgery is called “hybrid” does not mean it is easier, risk-free, or more suitable for everyone. Existing loss of support, skin coverage, the septum, and previous surgeries may limit the options. The same goal may not be achieved through the same approach in every patient.
For me, the value of this approach lies in the fact that it offers more options. The surgical plan should aim not to validate the name of the method, but to address the patient’s anatomical needs. The balance between protection and support is therefore determined on a case-by-case basis.
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 and Erhan Coşkun · co-authored article
Barış Çakır · one of seven co-editors; QMP
Sergio Furtado, Enrico Robotti, Antonio Sousa Vieira, Barış Çakır, Dunja Milicic · co-authored article
Barış Çakır and his colleagues · co-authored article
A treatment plan is developed by taking into account your nasal anatomy, your breathing difficulties, and your expectations.
Frequently Asked Questions About the Structure-Preservation Approach.
It does not describe a single standard sequence of procedures. It is a decision-making approach in which protective principles and structural supports are used in combination based on the patient’s anatomical needs.
On this page, I use the term “Structure-Preservation” to refer to an approach that addresses both structure and preservation. The published title of the book I co-edited is “Structural Preservation Rhinoplasty.”
It may not be possible to provide the same level of protection for every patient and in every area. The width, curvature, or support issues that require replacement, as well as the connections that need to be preserved, are evaluated on a case-by-case basis.
Yes. Preserving the integrity of one area does not eliminate the need for support in another area. Graft requirements and sources are planned on an individual basis.
Hybrid techniques for these anatomical variations have been published. However, the fact that such patients were identified in one study does not mean that the same method is appropriate for every nose that appears similar.
No. It refers to a specific technical approach for large and deviated noses. It is not a mandatory step in every corrective surgery or a universal solution for all deviations.
No. Access routes and decisions regarding protection and support are distinct from one another. The choice between an open or closed approach depends on the planned procedures and the clinical evaluation.
Facial and nasal analysis, airway assessment, skin and cartilage characteristics, previous surgeries, and the patient’s expectations are all considered together. The technical term takes on its meaning following this assessment.
You can request an appointment to discuss your personal expectations and options.