Many people choose to get a rhinoplasty to remove a dorsal hump or a “bump” – that is, a nose bridge that is curved downward rather than straight. In severe cases, some patients describe this kind of nose as resembling a “beak.” For the past 60+ years, facial surgeons have remedied this by lifting up the skin, chiseling off some of the bone directly under the surface of the skin to flatten the hump, and then reconstructing the nose bridge into the desired shape. Though usually effective, working directly under the tissue like that can cause complications – most commonly any of these three: (1) The separation of the tissues from the underlying hump-bone and cartilage may cause swelling to last for years, (2) bone may develop “callouses” after being cut or filed down, and (3) placing cartilage to fill empty gaps after removing the hump may cause the nose bridge to look asymmetrical.
Preservation rhinoplasty is an alternative approach that involves removing and reshaping bone much deeper under the surface, in a way that does not disturb the skin and connective tissues on your nose bridge. Typically, the initial swelling is not as severe or long-lasting, and the overall recovery time is shorter.
Dr. Michel Siegel is a rhinoplasty specialist in Houston, and offers preservation rhinoplasty as an option. Consider a preservation rhinoplasty if you are especially interested in minimal pain, no bruising, a short recovery time, and a perfectly reshaped nose that doesn’t look like it ever had surgery.
We look forward to helping you achieve your best look. You can contact us today to book a consultation with Dr. Siegel (in-office here in Houston or over Zoom), or read on to find out more about how preservation rhinoplasty works and how it can produce the nose that’s best for you.
What Happens in a Traditional Rhinoplasty
In a traditional rhinoplasty, the skin is separated from the underlying bone and cartilage in preparation to remove the hump.
The hump is made up of two components: bone and cartilage. The bone is chiseled off, and the cartilage is trimmed to reshape the bridge of the nose.
After the removal of the hump, an empty space is left, which often makes the nose appear wide and flat.
To create the proper shape after hump removal, the bridge is “reconstructed”: the bones are cut from the side to bring them closer together, which commonly known as “breaking the nose” (the red dotted lines in the figure below) and its top is filed down to smooth out imperfections. The gap left by the cartilage removal is filled in (the yellow pieces in the figure below).
Once the work on the bone and cartilage is completed, and the new bridge has been shaped, the skin is placed back to its natural position.
What Happens in a Preservation Rhinoplasty
Preservation rhinoplasty “preserves” the integrity of the nose and prevents many possible complications by leaving the entire bridge of the nose undisturbed. The cartilage and bony hump are removed from deep under the surface of the nose, which leaves intact all of the connections between the bone, cartilage, and other tissues.
In this illustration of a preservation rhinoplasty for a nose with a small hump – shown below – the bridge of the nose is untouched, and the bony hump is reduced by moving the bone portion of the hump closer to the face (the orange dotted line in the drawing below). Then, rather than cut cartilage away from the surface, the surgeon removes cartilage from below the bridge. That allows the cartilage to move down, and align itself with the new position of the bone.
In a preservation rhinoplasty for a nose with a large hump – shown below – a small segment of bone below the hump can be removed to allow the bony portion of the nose to move closer to the face, bringing the bony hump down with it. The cartilage portion of the hump is also removed from “under” the surface, which then allows proper alignment of the cartilage with the bone, creating a new bridge.
The main difference between a “small” preservation rhinoplasty (one for a small hump) and a “big” preservation rhinoplasty (one for a large hump) is the location of the bone that is removed, rather than how much bone is removed. Removing any amount of bone, particularly deep in the bone structure of the nose, can affect the entire shape of the nose. Because of that, a preservation rhinoplasty takes even more experience and skill than a traditional rhinoplasty takes.