Preservation rhinoplasty in Paris 16 — keeping the nasal dorsum

For a century, removing a hump has meant removing material: the excess bone and cartilage were rasped away, then the vault that this resection had just opened was closed again. The technique is reliable, it has proved itself, and it remains indicated in many situations.

Preservation rhinoplasty starts from a different idea: leave the dorsum of the nose alone, and lower it by removing height underneath. The natural profile of the dorsum, the one nature drew, comes down instead of being rebuilt.

This is not a superior technique. It is another way of solving the same problem, with its own indications and its own limits — and it is at the consultation, on one particular nose, that one or the other becomes the right answer.

What is preservation rhinoplasty?

The dorsum of the nose is not a simple line: it is a vault, made of two slopes meeting at the ridge. Reducing a hump by resection amounts to taking off the crest of that vault, which leaves an open surface the surgeon must then close by bringing the walls together.

Preservation avoids that opening. The vault stays intact; it is its support, underneath, that is lowered — by a resection at the level of the septum and the bony base. The dorsum comes down as one piece, without being reshaped.

The term also covers a second idea, less well known and just as important: preserving the soft tissues and the ligaments of the nasal pyramid, which extensive dissections used to sacrifice without necessity.

How does it differ from a classic rhinoplasty?

The difference cannot be seen in a photograph taken the next day. It is judged over time, and it concerns three points.

The profile of the dorsum. A preserved vault keeps its original light. A rebuilt vault may, over the years, show the junction line of the walls that were brought together — all the more visible where the skin is thin.

Long-term irregularities. They are the classic price of large resections in thin skin: what is perfectly smooth at three months may show at three years, once the swelling has completely gone.

The internal valve. The breathing space beneath the dorsum is altered by a resection; it is preserved by preservation. That guarantees nothing, but it removes one possible cause of secondary breathing difficulty.

In return, preservation imposes constraints that resection does not. That is the next point.

Is every hump suitable?

No, and that is the first thing to say.

The technique requires a manoeuvre that passes through the septum, the partition separating the two nasal cavities. A marked septal deviation, a septum already operated on, a fragile or fractured septum complicate or rule out that manoeuvre.

The shape of the hump also counts. A high, angular hump, a hump with a double break, a wide vault do not all come down in the same way, and some still call for reshaping.

Finally, preservation lowers the dorsum; it does not narrow it. A nose with a wide vault may therefore require an additional step.

In practice the two approaches are often combined: preserving the dorsum and working on the tip along classic lines is a frequent and perfectly coherent pairing.

Who this procedure suits — and who it does not

It particularly suits a moderate hump on a sound septum, in a person with thin skin — the profile in which the late irregularities of resection show the most. It also suits anyone who wishes to keep the character of their nasal dorsum while reducing its height.

It does not suit where the septum is markedly deviated, already operated on, or too fragile to bear the manoeuvre; where the vault has to be narrowed as much as lowered; and where the request concerns a transformation that only a reconstruction can achieve. In those cases the resection technique is not a second choice: it is the right answer.

Limits and specific risks

To the risks common to any rhinoplasty — imperfections of result, bleeding, infection, transient disturbance of smell, breathing difficulty — two points specific to this approach are added.

Recurrence of the hump is the best-documented risk: a lowered vault may rise partially again in the following months if the lowering has not been sufficiently stabilised. It is prevented by the fixation technique, and it is among the reasons for revision.

A later revision, should it become necessary, is carried out on an anatomy different from that of a resection rhinoplasty. This is not a contraindication, but it deserves to be known before choosing.

As with any rhinoplasty, swelling at the tip takes twelve to eighteen months to disappear completely, and no revision is considered before one year.

What is ultrasonic bone surgery?

The bony stage of a rhinoplasty — reducing a hump, narrowing the walls — was traditionally done with a rasp and an osteotome. For this I use an ultrasonic instrument, known as piezo surgery.

Its value rests on a simple property: ultrasonic vibration cuts bone and spares the soft tissues around it — lining, vessels, cartilage. A cutting instrument makes no such distinction.

In practice this allows finer work on the bone, and patients often report less marked bruising. It changes nothing about the timetable of the result: swelling at the tip follows the same course, and the final nose is still judged at one year.

How is the operation carried out?

Under general anaesthetic, most often with one night in hospital. The approach is closed in the majority of cases, inside the nostrils, with no visible scar.

The operation ends as a classic rhinoplasty does: a custom-made splint and packing in the nasal passages.

Stopping smoking is required before and after, for the same vascular reasons.

What is the recovery like?

It does not differ from that of a resection rhinoplasty: packing removed the next day, splint between the eighth and tenth day, bruising of the eyelids for about ten days, a blocked nose more troublesome than painful.

Contact sports and glasses pressing on the bridge are deferred; the precise interval is given to you on discharge.

Is follow-up different after preservation rhinoplasty?

The calendar is the same: splint removed between the fifth and the seventh day at the first consultation, a second between day ten and day fourteen. What differs comes from the technique itself — the bony framework is not resected, so bruising is often less — but swelling asks for the same patience and the same follow-up. Nurses for local care, the anaesthetist for pain, manual lymphatic drainage and hyperbaric oxygen where indicated. The full protocol appears on the page covering post-operative care.

When is the result final?

At one year, as with any rhinoplasty. The first three months give a direction, not a result.

One nuance is worth knowing: the dorsum having been preserved, its final shape is sometimes apparent earlier than that of a rebuilt vault. The tip, however, follows the same slow timetable as in any rhinoplasty.

Is this technique reimbursed?

Like any rhinoplasty carried out for aesthetic reasons, it is not reimbursed by French health insurance. Where a functional septal procedure is combined with it and the breathing difficulty is documented, that component may be eligible for partial reimbursement.

Frequently asked questions

Is preservation rhinoplasty a recent technique?

The principle is old — it was described in the middle of the last century — but it was little practised for several decades, resection having established itself as the standard. It has seen renewed interest over the past ten years or so, with better codified instruments and landmarks.

Is the result more natural?

On the dorsum, keeping the original vault gives a profile that did not have to be redrawn, and that is its main benefit. But the naturalness of a result does not rest on the dorsum alone: it rests on the tip, on the angle with the lip, and on the balance with the rest of the face. No technique exempts anyone from that analysis.

Can this particular technique be requested?

You may request it, and the question is a legitimate one. The answer depends on your septum, on the shape of your hump and on your skin. If your anatomy is not suitable, I will tell you so and explain why rather than force an indication.

How much time off is needed?

About ten days, as for a resection rhinoplasty.

Last updated: August 2026 · Medical content reviewed by Dr Benjamin Pulvermacker, qualified plastic surgeon in Paris 16.