Rhinoplasty is one of the most intricate and sought-after cosmetic surgeries, allowing patients to refine the appearance of their nose or improve its function. With advancements in surgical techniques, patients now have options when it comes to the approach used for their procedure. Dr. David L. Cangello, a renowned plastic surgeon in New York City, is one of the first surgeons in the country to perform preservation rhinoplasty and has one of the longest experiences with this technique in the U.S. Specializing in both traditional and preservation rhinoplasty, Dr. Cangello offers tailored solutions for each patient. While preservation rhinoplasty is one of the latest innovations, traditional rhinoplasty is still an important option, depending on the patient’s needs.
What is Structural Rhinoplasty?
Structural rhinoplasty, also known as traditional rhinoplasty, is a well-established method of nose surgery that involves altering the framework of the nose to achieve the desired outcome. This approach involves reducing the height of the nasal dorsum (the bridge) by removing bone and cartilage from the top of the nose. Doing so separates key structures such as the upper lateral cartilages and nasal bones from the septum, which then require reconstruction to create a smooth and continuous dorsum. This reconstruction allows surgeons to achieve dramatic changes and address complex nasal deformities.
Structural rhinoplasty is ideal for patients with significant cosmetic or functional concerns or those requiring revision surgery. It is also for patients who do not have ideal dorsal aesthetic lines to begin with. Since preservation rhinoplasty functions to preserve the nasal dorsum, the dorsal aesthetic lines should be relatively close to ideal to begin with. For example, a person with very wide dorsal aesthetic lines or severe cartilage or bony irregularity of the dorsum causing the dorsal aesthetic lines to be less than ideal, would be a candidate for structural rhinoplasty which can make them more ideal.
While this approach involves deconstructing and reconstructing parts of the nose, it provides unmatched flexibility to achieve transformative results. Dr. Cangello’s expertise ensures that reconstruction is performed with precision, minimizing the risk of irregularities and maintaining both the function and aesthetics of the nose. For patients seeking extensive reshaping, this method remains an essential option.
What is Preservation Rhinoplasty?
Preservation rhinoplasty, also known as dorsal preservation rhinoplasty, takes a different approach by maintaining the integrity of the nasal dorsum. Instead of removing cartilage and bone from the top of the dorsum, this technique carefully repositions and reshapes tissue from beneath, leaving the surface structures intact. After cartilage and bone are removed from underneath the dorsum, it can then be pushed or let down toward the face, thus reducing the height of the dorsum while simultaneously straightening it. This avoids the need for reconstruction and allows the natural dorsum to remain in place while achieving a refined and straightened appearance on frontal view for those with crooked or deviated noses and on profile view for those with overprojected or convex noses with a dorsal hump.
Because the dorsum is left intact, preservation rhinoplasty requires less grafting, reducing the chance of irregularities or an “operated” look. This technique can produce dramatic changes while preserving the nose’s natural aesthetic lines, making it ideal for patients with good dorsal contour who wish to enhance their appearance without compromising the original framework.
Dr. Cangello has been a pioneer in preservation rhinoplasty, and was one of the first rhinoplasty surgeons in the United States to perform this advanced technique. He has used the reservation technique since 2019 and achieved consistently natural-looking results. His extensive experience allows him to assess each patient’s unique anatomy and deliver personalized outcomes that enhance both aesthetics and function.
Key Differences Between Structural and Preservation Rhinoplasty
While both structural and preservation rhinoplasty can deliver transformative results, they are distinct in their techniques and outcomes.
- Aesthetic Results: Preservation rhinoplasty provides the most natural results because the dorsum remains untouched. This allows patients to retain the appearance of their original nasal structure, which is difficult to replicate when the dorsum is removed and reconstructed during structural rhinoplasty. While experienced surgeons like Dr. Cangello perform meticulous reconstruction to achieve beautiful results with the structural approach, the reconstructed dorsum can never replicate the natural one exactly. For less experienced or detail-oriented surgeons, structural rhinoplasty may carry a greater risk of irregularities. Importantly, preservation rhinoplasty is not limited to subtle refinements—it is equally effective for making major changes to the nose.
- Surgical Technique: In traditional rhinoplasty, surgeons reduce the height of the nasal dorsum (the bridge) by removing cartilage and bone from the top. In preservation rhinoplasty, Dr. Cangello removes cartilage and bone from underneath, allowing for more precise and natural nose reshaping, because the dorsum is untouched. It is also an extremely powerful tool for correction of the deviated nose.
- Nasal Function: Preservation rhinoplasty carries a lower risk of impacting nasal function because the dorsum is left intact, avoiding the need for reconstruction. This eliminates the risk of cartilage collapse and narrowing of the internal nasal valve, which can occur with poorly performed structural rhinoplasty. When traditional rhinoplasty is performed by an experienced surgeon like Dr. Cangello, the risk of breathing issues is extremely low. However, preservation rhinoplasty inherently reduces this risk even further by preserving the nasal structures necessary for optimal airflow.
Benefits of Preservation Rhinoplasty
Preservation rhinoplasty offers several key advantages that make it a popular choice for patients seeking natural-looking results. These benefits include:
- Preserving the natural structure and function of the nose.
- Maintaining the bridge of the nose while reducing bumps or humps or overprojecting noses.
- Providing an excellent technique for correcting a deviated or tilted nose.
- A refined, natural appearance without the “operated” look often associated with inadequately performed structurally approached procedures.
When Structural Rhinoplasty May Be the Right Choice
While preservation rhinoplasty offers many benefits, it may not be the right choice for every patient. Traditional rhinoplasty remains an essential option for individuals with more complex nasal concerns, such as significant deformities, widely set dorsal aesthetic lines, or an irregular dorsum that does not follow a smooth, natural curve from the medial brow to the nasal tip. For example, if a patient has a wide bump in the middle of the dorsum, the structural approach may be necessary to refine the nasal contour. Additionally, traditional rhinoplasty is often the preferred method for those who have undergone previous rhinoplasty and require revision rhinoplasty surgery.
Below is an example of a nose that is well-suited for preservation rhinoplasty. The dorsal aesthetic lines are naturally well-defined and harmonious, making it possible to refine the shape while keeping the original framework intact.
However, in cases where the dorsal aesthetic lines are excessively wide, irregular, or disrupted—such as a nose with a wide bump in the middle of the dorsum—the structural approach may be necessary. This technique allows for precise reshaping to achieve a more balanced and refined appearance.
Dr. Cangello carefully evaluates each patient to determine the most appropriate approach. By assessing the unique characteristics of each nose, he ensures that the chosen technique will achieve the most natural and aesthetically pleasing result.
Which Procedure is Right for You?
Choosing between structural and preservation rhinoplasty depends on various factors, including the desired outcome, the extent of nasal reshaping needed, and any functional concerns. Patients looking for subtle changes with minimal recovery time may benefit from preservation rhinoplasty. Those needing more extensive correction or revision surgery may find that traditional rhinoplasty is the best choice.
During your consultation, Dr. Cangello will guide you through your options and recommend the technique that best aligns with your aesthetic goals and the natural structure of your nose.
Achieve Your Ideal Nose with the Right Rhinoplasty Approach
Both structural and preservation rhinoplasty are effective methods for achieving a more balanced and attractive nose. By understanding the differences between the two techniques, you can make an informed decision about which approach is right for you. Whether you are seeking subtle refinement or a more dramatic transformation, Dr. Cangello’s expertise ensures that your rhinoplasty results are tailored to your needs and goals.
To learn more about rhinoplasty and explore which procedure is best for you, schedule a consultation with Dr. Cangello in New York City today.