In order to reach everyone and be easily understood, imagine that we are able to modify a large dorsal hump by making only a series of cuts and resections in the septum and bones, in such a way that we don’t touch neither the skin nor the dorsal surface of the nose.
In this way:
- Contour irregularities on the dorsum are avoided.
- The dorsal aesthetic lines are kept intact.
- Inverted V deformities caused by classic hump resection are avoided.
- Internal valve stenosis problems that could lead to breathing problems are avoided.
This philosophy has been gaining popularity over the past decade, largely due to a better and more detailed understanding of nasal anatomy and improved surgical techniques and tools.
Dr. Tarragona is a pioneer of this technique in Spain, training in Europe and Turkey and performing the first cases of this novel technique in Barcelona.
The basic principles are:
- Preservation of the anatomy of the nasal dorsum.
- Subperichondrial dissection (perichondrium is a layer of tissue intimately attached to the cartilage, so if we leave this layer attached to the skin and not to the cartilage, once the appropriate modifications have been made to the structure of the nose, the skin coverage is thicker and can better camouflage any asymmetry or irregularity of the underlying skeleton).
- Ligament preservation (scroll ligament and Pitanguy ligament). Ligaments play a very important role in tip support mechanisms and in the contouring of the different nasal subunits.
- Less resection of the tip cartilages and more flaps to strengthen these cartilages.
Shortly, it consists of preserving everything that we consider beautiful and putting special interest in the treatment not only of the supporting structures such as bone and cartilage, but also in how we handle the soft tissues. The maximum preservation of these structures allows a better aging of the nose and preserve the peculiarities that make special and unique to each individual considering rhinoplasty.
Preservation techniques can be performed open (by making a cut in the columella) or closed (through intranasal incisions that are not visible to the naked eye). The closed approach allows a faster recovery, less swelling, and scars are not visible.
Depending on the type of nose of each patient, septum deviations, cartilage consistency, skin type, previous trauma, previous operations… some techniques or others will be indicated.
The term ‘ultrasonic’ that has been given to rhinoplasty in recent years, is not by itself a type of rhinoplasty, but refers to the method by which the bones are treated. Bones can be treated by mechanical methods (rasps, saws, osteotomes… ), motor-assisted devices (contouring burs) or ultrasound-assisted devices (ultrasonic or piezoelectric scalpel). Taking that into consideration, the bone work in a rhinoplasty accounts for 10-20% of the surgical time regardless of the method used. The rest of the time is spent in meticulous dissection of the nose, septum and turbinates work, taking cartilage grafts, nasal tip, and soft tissue maneuvers to achieve an adequate balance between the different nasal subunits. Therefore, the term ultrasonic does not represent ‘per se’ an entity with sufficient weight to classify a type of rhinoplasty, being classifications with more entity the open/closed approach, structural/preservation or primary/secondary.