Dorsal Preservation Rhinoplasty
This technique differs fundamentally from traditional dorsal-resection or structural approaches.
Find out how this technique compares to structural rhinoplasty and whether one or the other may be better for your nose surgery.
The principles of dorsal preservation rhinoplasty date back more than a century, with early techniques described by surgeons including Goodale, Lothrop, and later Cottle. The modern approach has since been advanced and refined by surgeons such as Dr. Yves Saban and Dr. Teoman Dogan (Dr. Teo) of Istanbul. Dr. Athré completed fellowship training with Dr. Dogan in Istanbul, Turkey, where he gained focused experience in dorsal preservation rhinoplasty and its modern surgical techniques.
Dorsal preservation rhinoplasty is a distinct approach that differs from traditional dorsal-resection and structural rhinoplasty techniques. This is in contrast to ultrasonic rhinoplasty, which refers primarily to the use of piezoelectric/ultrasonic instruments for precise bone reshaping rather than to a separate overall rhinoplasty philosophy.
“Dr. Athré did an amazing job on my nose. His staff treated me like family and I felt very comfortable getting the work done."
Benefits of Dorsal Preservation Rhinoplasty
The name describes the basic concept: rather than removing the nasal dorsum, the surgeon preserves its continuity and repositions or reshapes it.
In a traditional dorsal-resection approach, the prominent portion of the nasal bridge—the ‘top of the mountain’ in this analogy—is removed and the dorsum is then reconstructed as needed. In a push-down dorsal preservation technique, the osseocartilaginous nasal vault is mobilized and lowered as a unit.
The dotted line shows the preoperative height of the bony dorsum. The green line shows the postoperative position of the dorsum after preservation rhinoplasty. You can see that the nasal vault has been mobilized and lowered while preserving the continuity of the dorsum. The red arrows indicate the osteotomy sites at the junction of the nasal bones and the maxilla (upper jaw).
The push-down technique is one form of dorsal preservation rhinoplasty. A precisely measured portion of septal cartilage is removed or modified to create room for the nasal dorsum to be lowered.
Before & After Photos
Rhinoplasty Gallery
Why Dorsal Preservation Rhinoplasty
Advantages Over Traditional Rhinoplasty
The defining principle of dorsal preservation rhinoplasty is keeping the natural structure of the nasal bridge intact. Rather than removing the dorsal hump and reconstructing the bridge, the surgeon reshapes and repositions the existing structure.
From a surgical perspective, preserving native dorsal anatomy may reduce the amount of reconstruction required and some of the healing variables associated with dorsal hump resection. After traditional dorsal hump resection and reconstruction, potential complications can include:
- Bony callus formation or contour irregularities at sites of bone healing.
- Visible and/or palpable irregularities in the dorsum due to cartilage modification in the healing period.
- An inverted-V deformity, which can occur when the upper lateral cartilages lose adequate support or separate from the nasal bones after dorsal hump reduction. This risk is particularly relevant when a substantial dorsal hump is removed without adequate reconstruction of the middle vault.
Dorsal preservation may reduce the risk of some dorsal irregularities associated with traditional hump resection because the native osseocartilaginous dorsum is preserved.
Patient Benefits
Because dorsal preservation rhinoplasty maintains more of the nose's native anatomy and may require less disruption of certain tissue planes, appropriately selected patients may experience benefits such as:
- Reduced bleeding
- Reduced swelling and bruising
- Less postoperative discomfort
- A shorter early recovery period
Recovery varies from patient to patient and depends on the extent of surgery performed. In Dr. Athré's experience, many dorsal preservation patients feel comfortable resuming some routine activities within several days, although swelling and healing continue well beyond this initial recovery period.
The patient shown here is four days after dorsal preservation rhinoplasty. She required no nasal packing and had minimal visible bruising.
Advantages
Potential Advantages of Dorsal Preservation Rhinoplasty
Dr. Athré has further modified dorsal preservation rhinoplasty by adding the ultrasonic technique and the Athré strut.
The Athré strut is a small cartilage graft designed to:
- Support tip rotation or projection
- Improve tip definition
- Help maintain tip support over time
See below for a pictorial representation.
The green cartilage strut represents the Athré strut (also called ‘El Cuerno). This strut lifts, defines, and stabilizes the nasal tip of the nose providing structural support intended to help maintain a defined, stable nasal tip over time.
These modifications reflect Dr. Athré’s ongoing refinement of his rhinoplasty techniques to improve consistency while adapting the operation to each patient’s anatomy.
Although dorsal preservation is frequently used in our practice, it is not appropriate for every patient; candidacy depends on nasal anatomy and the goals of surgery.
When reading about all of these techniques, the reader needs to realize that there is no perfect technique that works for every patient. No single rhinoplasty technique is appropriate for every patient. The purpose of these pages is to explain the available techniques and help patients understand the potential advantages and limitations of each.
Dr. Athré believes rhinoplasty surgeons should be familiar with a broad range of techniques so they can adapt the operation to each patient’s anatomy and surgical needs. This gives the surgeon a repertoire of options because because different anatomical and surgical challenges may require different approaches.
Why Dr. Athré for Rhinoplasty?
Dr. Athré treats rhinoplasty patients from Houston as well as patients who travel from across the United States and internationally.
He continually evaluates, refines, and adapts rhinoplasty techniques to achieve natural, consistent results.
Approximately 75–80% of Dr. Athré’s rhinoplasty practice is primary rhinoplasty, with revision rhinoplasty being 20–25% of his practice. Rhinoplasty represents a substantial portion of Dr. Athré’s surgical practice, giving him extensive experience with both primary and revision cases.
Patient Review
“Dr. Athré did an amazing job on my nose. His staff treated me like family and I felt very comfortable getting the work done. He was very intuitive on what I was trying to accomplish and knowledgable enough to work through the issues involved to get the result I wanted, especially considering it was a revision surgery. The whole experience was great and helped me so much!”
