Structural and Preservation Rhinoplasty
An individualized approach to nasal aesthetics, structural support and breathing function. A well-executed rhinoplasty brings harmony to the face without drawing attention to itself.
Rhinoplasty is a surgical procedure to refine the shape and function of the nose, it is one of the most technically demanding and artistically sensitive procedures in plastic surgery. Whether the goal is to improve breathing, refine a nasal hump, or reshape the tip. The nose plays a central role in facial aesthetics, and even subtle changes can dramatically enhance balance and beauty.
What rhinoplasty can address:
Improve nasal breathing by correcting functional issues
Reduce a dorsal hump or irregular dorsal lines
Refine the nasal tip or reshape the nostrils
Nasal deviation or asymmetry
Tip position, projection, rotation or definition
Wide, asymmetric or retracted nostrils
Septal deviation or nasal-valve weakness affecting breathing
Structural problems following trauma or previous rhinoplasty
Imbalance between the nose, chin and other facial proportions.
Structural versus preservation rhinoplasty
There is no single technique that suits every nose. I select the approach according to the patient’s anatomy, skin thickness, existing support, breathing function and previous surgery.
Structural rhinoplasty
Structural rhinoplasty modifies and reinforces the nasal framework using cartilage sutures and grafts. Cartilage is usually obtained from the septum; ear or rib cartilage may be required when additional material or stronger support is needed.
I use structural techniques in most cases, particularly when treating:
Significant deviation or asymmetry
Weak or poorly positioned tip cartilages
Thick skin requiring stronger underlying definition
Nasal-valve weakness or structural airway problems
Trauma-related deformity or revision rhinoplasty
Scar contracture or loss of structural support
The objective is not to make the nose rigid or graft-heavy. It is to create sufficient support so that the intended shape and breathing function remain reliable during healing.
Preservation rhinoplasty
Preservation rhinoplasty aims to reshape the nose while maintaining selected native structures, particularly the continuity of the nasal dorsum.
In suitable patients, the hump can be lowered by repositioning the entire dorsal framework (under the surface) rather than removing and reconstructing its surface. This can preserve natural dorsal lines and avoid unnecessary disruption of normal anatomy.
Preservation techniques are most appropriate in selected primary rhinoplasties with favourable dorsal and septal anatomy, such as minimal asymmetry, high radix and good skin quality. They are not automatically less invasive or superior, and they are not suitable for every deformity.
Tip refinement, septal correction and cartilage grafting may still be necessary even when the dorsum is treated with a preservation technique.
A combined approach
Structural and preservation rhinoplasty are not mutually exclusive. In some patients, I preserve the dorsal anatomy while using structural techniques to control the tip, improve breathing or reinforce areas of weakness.
Consultation and surgical planning
Rhinoplasty planning begins with a detailed assessment of the nose as part of the entire face. The objective is not simply to reduce a hump or refine the tip, but to understand how every change affects facial proportions, nasal support and breathing.
During consultation, I assess:
Nasal length, projection and rotation
Forehead and nasal radix position and dorsal contour
Tip shape, support and cartilage orientation
Skin thickness and soft-tissue characteristics
Nasal bones, septum and dorsal asymmetry
Nostril shape, alar position and the nasal base
Internal and external nasal valves
The relationship between the nose, lips, chin and forehead
Previous trauma, surgery or breathing symptoms
Standardized photographs and measurements are used to analyse the nose from multiple views. Digital morphing (Photoshop) is used to preview possible outcomes, while not a guarantee, it gives you a helpful visual reference for the direction of change, so we are on the same page when it comes to dorsal profile, degree of rotation and projection. Healing, swelling, scar formation and the behaviour of the skin cannot unfortunately be predicted with complete precision.