Preservation Techniques in Rhinoplasty

Preservation rhinoplasty has emerged as a unifying principle that seeks to maintain the native anatomy of the nasal dorsum and septum while achieving both functional improvement and aesthetic refinement. Rather than excising bone and cartilage en bloc, surgeons employ controlled subdorsal resections, pushdown or letdown osteotomies and subtle reshaping of the septal framework to conserve structural integrity. The intact L-strut of septal cartilage provides critical support for the tip and dorsum, and its preservation minimises risk of collapse or saddling. Advances in three-dimensional imaging, finite-element modelling and biomimetic approaches have informed techniques that respect the biomechanics of nasal tissues. By combining conservative osteotomies with precise cartilage grafting and an understanding of muscular attachments, preservation rhinoplasty offers improved postoperative stability, reduced complication rates and natural contour harmony while addressing both aesthetic and airway concerns.

Research from Nature Portfolio

Recent work has employed microdissection, histological staining and microcomputed tomography to delineate the attachment patterns of the depressor septi nasi and orbicularis oris muscles to the medial crus of the major alar cartilage. Investigators identified six distinct anatomical variants defined by crossing muscle fibres and quantified their prevalence in adult cadaveric specimens. These findings clarify how dynamic nasal tip movements are influenced by muscular footplate orientation and support the selective preservation of these attachments during rhinoplasty. By integrating this anatomical evidence, surgeons can tailor tip-support maneuvers to conserve natural muscular function and reduce postoperative asymmetry.

Preservation Techniques in Rhinoplasty publication trend

The graph below shows the total number of articles in preservation techniques in rhinoplasty across all publications each year (not limited to Nature Index journals).

Technical terms

Preservation rhinoplasty: A surgical philosophy that avoids extensive resection of nasal bone and cartilage, aiming to maintain native anatomical frameworks.

L-strut: The dorsal and caudal segments of septal cartilage that form an “L” shape, essential for nasal tip and dorsum support.

Dorsal preservation: Techniques such as pushdown and letdown osteotomies that lower the nasal dorsum without direct hump removal.

Finite-element analysis: A computational modelling method used to predict stress, strain and deformation in biological tissues.

Depressor septi nasi: A muscle that inserts on the footplate of alar cartilages and creates dynamic downward forces on the nasal tip.

Orbicularis oris: The circular muscle around the mouth, some fibres of which attach to nasal cartilages and influence tip dynamics.

References

1. The Creation of an Average 3D Model of the Human Cartilaginous Nasal Septum and Its Biomimetic Applications. Biomimetics (2023).
2. Crossing fibers may underlie the dynamic pulling forces of muscles that attach to cartilage at the tip of the nose. Scientific Reports (2023).
3. Current Trends in Preservation Rhinoplasty. Aesthetic Surgery Journal Open Forum (2020).
4. Redefining the Septal L-Strut to Prevent Collapse. PLOS ONE (2016).
5. Septum pyramidal adjustment and repositioning – a conservative and effective rhinoplasty technique. Brazilian Journal of Otorhinolaryngology (2017).