Preservation Rhinoplasty

Dr. Rad uses an approach to “nose job” surgery called Preservation Rhinoplasty (PR) that can improve the appearance and function of the nose in a minimally invasive rhinoplasty manner. “Preservation” refers to preserving the ligaments, tissues and cartilages as much as possible, and avoiding removal of structures which is a feature of other methods. By preserving the structure of your nose, the stability of the nose is maximized, and risks of problems leading to revision surgery are minimized. Dr. Rad specializes in “closed” or “endonasal” preservation techniques which combine the best of both worlds: scarless (hidden incisions within the nostrils) and preservation of structure. Popularized by closed rhinoplasty surgeons from around the world, PR is the most modern and “cutting edge” approach in rhinoplasty today.

Preservation Rhinoplasty is a minimally invasive approach that was initially proposed over a century ago and has recently resurged in importance. The philosophy is centered on preserving, rather than dissecting or cutting through, nasal structures, specifically ligaments, the soft tissue envelope and cartilage. The idea is that minimal disturbance of the intrinsic, native structures that provide support to the nose will preserve stability. Can preservation rhinoplasty offer equally good results to other methods? Absolutely yes. This is why it has gained tremendous interest because minimizing invasiveness and achieving beautiful results should always be prioritized.

There are two main components: dorsal preservation and tip preservation. “Dorsal” refers to the “dorsum” or the bridge of the nose. Commonly patients who desire rhinoplasty wish to have a “hump” or convex bridge reduced to either a straight or slightly curved appearance. There are different methods of doing this. The traditional approach is “component dorsal reduction” which basically means removing (cutting off) the top of the hump. Preservation methods use a “push down” or “let down” which involves shifting the hump downwards without cutting off the top. Tip preservation means that we are preserving most of the ligaments that support tip shape, shaping the tip to the degree necessary, and then re-attaching the ligaments. The ligaments that are crucial to preserve are the “scroll ligament complex” and the “Pitanguy ligament”. By repairing these ligaments after tip shaping, the surgeon has more control over the supra tip break point, lateral alar definition and columella position. There are many technical details about preservation and closed methods, however the most important takeaway for patients is that Dr. Rad’s goals are focused on achieving best results while minimizing surgery and preserving native structures. This gives patients the best chance for enjoying a beautiful and functional nose with minimal risk of complications.

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“The beauty in a face should be noticed, not the work that went into it.”

- Ariel N Rad, MD, PhD, FACS

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preservation rhinoplasty before and after photos by sherber and rad in washington dc

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01Artistry

Artistry is at the heart of facial procedures because together we are searching for facial harmony and balance. All surgeons have a different degree of aesthetic sense, some more than others. Dr. Rad’s eye is trained to evaluate a nose both holistically and at the smallest details, looking for asymmetries and optimal contours. Dr. Rad spends time with you to formulate the best plan to achieve your goals. This often requires a combination of procedures, from neck lift, to chin augmentation and jawline slimming, as well as fat grafting. Each procedure is intended to correct subtle asymmetries in the face. But keep in mind that the art lies in the hands performing the procedures, not the procedures themselves. Just as a beautiful piano concerto stands in its own beauty, it’s the pianist who brings it to life, some better than others. Likewise, surgeons have different skill levels and aesthetic nuance, and bring to life the best results to varying degrees of ability. The level of artistry required to achieve natural, beautiful and long lasting results requires tremendous nuance. As Dr. Rad frequently says, “millimeter changes throughout the face can synergize beautifully into stunning yet natural results.” These details are reflected in surgeons’ before/after photographs which is why you must evaluate these with an aesthetic eye. You have only 1 face and so listen to your instincts when you look at surgeons’ results.

02safety

Dr. Rad’s highest priorities are your safety and comfort. A board-certified anesthesiologist will use a light general anesthesia which is very safe for healthy patients. You will remember nothing about the procedure, you will not feel any pain during the procedure, and you will wake up gently in the recovery room.

While a mix of excitement and anxiety is common, keep in mind that Dr. Rad works with a highly skilled team and risk of problems during surgery are extremely low and rare. For your safety, Dr. Rad performs surgery in a AAAASF certified operating facility (“AAAASF” is the highest standard of certification in the US.

03Technique

Dr. Rad uses the following technique while performing a preservation rhinoplasty:

1. The average duration of surgery is 2.5 to 3.5 hours depending on the complexity and desire goal of surgery

2. Although Dr. Rad is able to perform open or closed rhinoplasty, his preferred method is closed as this is minimally invasive and avoids external scars across the columella

3. If you have a dorsal hump then Dr. Rad employs a “dorsal preservation” approach where tissues are lifted under the “perichondrium and periosteum (strong layers overlying the cartilage and bone, respectively, the cartilage and bone are shaped to give the desired appearance, Dr. Rad uses a “let down” or a “push down” method to reduce the nasal pyramid to straight or gently curved. When performing a dorsal preservation rhinoplasty, Dr. Rad will bring down the bridge by removing small areas of cartilage or bone from below the dorsal hump and the top or bottom of the septum.

4. If you have a bulbous or asymmetric tip then “preservation tip-plasty” can improve the appearance and harmony of your nasal tip. Dr. Rad carefully separates the overlying soft tissues from the cartilages of your tip, and then shapes them with sutures and repositioning maneuvers to create the desired tip shape. Keep in mind that skin thickness is very important to take into consideration because thin skin will show edges more so than thick skin. This is like pillows on the bed – a thin bed sheet over the pillows will show the undulations and edges of the pillows, whereas a thick duvet comforter will not. Sometimes tissue thinning can be done but only very carefully as the tissues must be preserved.

5. Once the desired nasal shape is achieved then Dr. Rad checks symmetry, shape, and contour to be sure that your new nose balances beautifully with your facial features.

6. Then he closes the incisions and places internal and external nasal splints to support the underlying structures

04recovery

Recovery is a process of tissue healing and feeling back to normal that requires time. The length of time depends on which facial areas are treated, the complexity of surgery, and individual healing factors. The key principle of surgery that Dr. Rad always adheres to is minimizing surgery to achieve best results, thus minimizing healing and recovery time. Since each case is different, Dr. Rad will guide you through the recovery process with comprehensive information based on your unique situation.

Immediately after surgery, someone must drive you home from the surgical facility and stay with you for at least 24 hours. Recovery is approximately 7-10 days when swelling and bruising under the eyes can be visible by others. However, recovery is not exceedingly painful and discomfort is mild and controlled by pain medicine.

05Aftercare

Care post-surgery is important for both your recovery and results whether at your home or at a hotel. For your safety, as you’ll be somewhat sleepy, you will need a responsible adult to stay with you for at least the first night. If you’re interested in having an experienced private duty nurse, we can help facilitate this care.

Once home or in a hotel, you will mostly rest, although you should be able to perform “activities of daily living,” meaning being up and about and doing basic self care. Since your nose will be wrapped, you’ll defer showering until your first post-op appointment with Dr. Rad 1-2 days after surgery.

Since nausea is not uncommon after anesthesia, no matter how light the anesthesia given, nausea prevention is essential and straightforward by taking an anti-nausea medicine such as Zofran (Ondansetron). Nausea side effects typically wear off in 24-48 hours. Other side effects of anesthesia include feeling a bit groggy or “out of it”, but this is relatively mild and wears off quickly. Dr. Rad recommends not planning important work-related activities or phone calls as you will not feel your sharpest.

Drinking liquids is most important to maintain hydration. Dr. Rad recommends Gatorade, or Drip Drop and Liquid IV electrolyte replacement powders mixed in water. If neck lift has been done then patients often feel some neck tightness that is normal, common and temporary. You will have a 1-week post-operative check-up to make sure everything is going well. You and Dr. Rad will talk about what to expect during the next 6 weeks.

During the first week following your preservation rhinoplasty procedure, you should take it easy at home and rest. You may return to work from home if you feel comfortable doing so, and most patients feel recovered enough by day 3 or 4. However, keep in mind that you will have visible evidence of having had surgery and so staying off video teleconference may be best. Your voice will sound somewhat “nasal-y” during the week after surgery because your nose will have splints which congest the nasal passages. This is normal and temporary.

Some drainage from the nostrils is expected and you should keep the nostril rims clear of dried blood. Use nasal saline as needed.

Normal return to work following a preservation rhinoplasty procedure can occur in around 7-10 days. Your ability to return to work sooner will depend on the specifics of your job, so it is best to discuss this with Dr. Rad.

Patients can resume light exercise 2 weeks after, and ramp up to unrestricted activity 4 to 6 weeks after preservation rhinoplasty surgery. You can start light chores and light housework a few days after surgical treatment. Light outdoor walking may be possible, depending on your recovery. No heavy lifting or intense physical exercise for 4-6 weeks.

06longevity

Your vision for your results will emerge through detailed consultation with Dr. Rad, meticulous examination of your anatomy, and careful pre-surgical planning. While Dr. Rad’s surgical approach is unique for each patient, the goal of naturalness remains constant.

Over the course of 2-6 weeks post surgery, results will continue to develop with long-term recovery experienced around 6 to 12 months after the procedure. By this point, the majority of swelling and bruising should have resolved, and you should start seeing the full results of your preservation rhinoplasty. However, it’s important to note that individual healing rates can vary, and it may take several months for all swelling to completely dissipate and the final outcome to be evident.

frequently askedQuestions

Am I a good candidate for preservation rhinoplasty?

If you have never had surgery on your nose previously, and you are concerned to improve a bulbous nasal tip, dorsal hump (bump on bridge), droopy nose, crooked nasal tip, wide nostril base then preservation rhinoplasty may be the best option for you. Deviations from trauma may also be addressed with closed PR methods. However, if you have had severe trauma or you need corrective surgery from prior rhinoplasty, then preservation rhinoplasty may not be the best approach, and rather other “structural rhinoplasty” or closed grafting methods may be needed.

What is the cost of a preservation rhinoplasty at SHERBER+RAD?

Cost is multifactorial and starts at $9,500, increasing with complexity and length of surgery. We cannot give detailed quotes before consultation.

Note that pricing is customized for each patient and these guidelines do not necessarily apply uniformly. These are approximate ranges and total cost depends on multiple factors: your unique anatomy, goals, complexity of the procedures, recommended techniques, whether corrective work is needed, in-office or hospital-based operating facility, and combining multiple procedures (increasing concessions apply for multiple procedures).

Although you may receive varying cost estimates from other practices, keep in mind that your surgeon’s education and training, plastic surgery board certification, his/her experience (at least 8 years of experience after residency is recommended), and aesthetic artistry and surgical skill (i.e., talent) of your surgeon are important factors in pricing. Dr. Rad’s practice is solely focused on facial aesthetic surgery and his artistry is unmatched. His goal for every patient is to achieve nuanced and natural results with minimal recovery, and we have mechanisms in place to bring them within financial reach.

Testimonials

“Dr. Rad is not only a skilled and talented surgeon but a kind and compassionate doctor, who treats the whole person. For me, he exemplifies medical excellence.”

“He is the most gifted physician that I’ve ever met. Dr. Ariel Rad is in the top-echelon of physicians. He has a brilliant brain and a big heart. His skills as a surgeon are unparalleled.”

“He was very thorough, knowledgeable and most of all empathic to my situation.”

“He is not only a great surgeon, but an artist.”

“He is very skilled, his manner is absolutely delightful, and he is a truly kind, considerate person”

“He is an expert in his field. He is brilliant and very caring. I will never forget how compassionate he was on the day of my surgery”

“Dr. Rad is one of the world's best! His artistic eye and incredible skill shows in my incredible face lift results. His ability as a surgeon is surpassed only by his kindness and approachability as a person.”

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Next Steps

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Related Procedures

Preservation Rhinoplasty

- Ariel N Rad, MD, PhD, FACS

real patient resultsgallery

01Artistry

02safety

03Technique

04recovery

05Aftercare

06longevity

frequently askedQuestions

Am I a good candidate for preservation rhinoplasty?

What is the cost of a preservation rhinoplasty at SHERBER+RAD?

Testimonials

Next Steps

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