Preservation rhinoplasty.

The advantages of preservation rhinoplasty

When well indicated, preservation offers several benefits:

• soft, continuous dorsal lines, free of irregularities;
• a very natural result that respects the character of the face;
• better stability over time, since the structure is conserved;
• often, a simpler recovery.

A gentler recovery, without packing

Because the gesture respects the tissues and bleeds little, mastering it most often makes it possible to avoid nasal packing: no "mèches" in the nose. You breathe through your nose sooner and post-operative comfort is markedly improved. An external splint is worn for about a week, and the result then refines over the following weeks.

Preservation and ultrasound: the natural pairing

The two approaches often go hand in hand: ultrasonic rhinoplasty sculpts the bone with precision, while preservation conserves the architecture. Together, they aim for a natural, stable and lasting result.

How is a preservation rhinoplasty performed?

To lower the bridge of the nose (the dorsum) without touching its surface, the work is done deeper down: the surgeon operates on the septum and on the deep structures, which allow the whole dorsum to be repositioned. The surface itself is left intact — this is what preserves the original lines of the nose.

The tip can be reshaped at the same time when needed, again keeping the existing cartilage as far as possible rather than removing it.

The technique adapts to each anatomy. A precise analysis of the nose, the septum, the thickness of the skin and the proportions of the face is essential beforehand: it is carried out during the consultation, with a simulation.

Push-down and let-down: what is the difference?

These are two variants of preservation rhinoplasty. Both lower the bridge as a single unit, to keep its continuity; they differ in how the bone is released so that it can come down.

The push-down lowers the bridge without removing a strip of bone at the sides: the ridge is repositioned downwards while keeping its structure.

The let-down follows the same principle, but may require the removal of a thin lateral strip of bone to allow that lowering.

The choice depends on the height of the hump, the width of the nose, the bone and cartilage anatomy, and the result sought. There is no universal technique: the indication is decided nose by nose.

In practice, when the bony component of the hump is significant, Dr Lange favours the let-down. The subject is developed on the nasal hump page.

Preservation or structural rhinoplasty?

The two approaches are not opposites: they are two surgical strategies, and they can even be combined during the same procedure.

Preservation keeps the natural structures as far as possible, in particular the continuity of the bridge. It is especially useful when a hump or certain proportions can be corrected without rebuilding the whole architecture.

Structural rhinoplasty modifies the bone and cartilage more directly. It becomes necessary in some complex anatomies, with significant deformities, or when reconstruction is required — often the case with revisions.

The choice depends on your starting anatomy, any breathing difficulty, your surgical history and your goals. The point is not to apply one technique, but to choose the one that will give a natural, harmonious and stable result.

Who is it for? Indications, limits and risks

Preservation is particularly suited to noses with a moderate hump and good starting lines. It does, however, have its limits: some significant deformities, very large humps or previously operated noses (revisions) may require reconstruction techniques. The indication is established case by case during the consultation.

Like any surgical procedure, it carries risks. In the days that follow, swelling and bruising are usual; the nose then evolves gradually, and the final result can only be judged once the swelling has gone — the stages are detailed in recovery.

As with any rhinoplasty, there is a risk of asymmetry, irregularity, insufficient or excessive correction, breathing difficulty, or the need for a surgical touch-up. A partial return of the convexity of the bridge is also possible. These points are gone through during the pre-operative consultation, together with the SOFCPRE information sheet (opens in a new window).

Why choose Dr Lange in Montpellier?

A plastic surgeon dedicated exclusively to rhinoplasty in Montpellier, Dr Frédéric Lange masters preservation rhinoplasty, ultrasonic techniques and reconstruction, in order to choose, each time, the approach best suited to your nose. Every project begins with a detailed consultation and a realistic simulation.