Posted by Dr. Anil R. Shah
We’re talking about the different types of rhinoplasty terms that have come out recently. These types of rhinoplasty are a traditional rhinoplasty, open rhinoplasty, closed rhinoplasty, an ultrasonic rhinoplasty, piezo rhinoplasty, and a preservation rhinoplasty. So let’s talk about all the differences between these terms.
Traditional Rhinoplasty
Traditional rhinoplasty is typically going to be a reductive rhinoplasty where you’re removing parts of the nose from the outside. In some cases, there is reconstructing involved during traditional rhinoplasty. During reconstructing, either an open or closed technique is used. Let’s define these.
An open technique is when there’s an incision on the bottom of your nose. The area on the bottom of your nose in the middle, the skin between your nostrils, is called the columella. Typically, the scar from this approach is hard to see, although it can be present in some patients if you really look for it. Some patients may not scar as well as others.
A closed rhinoplasty is where you can do all this with the scars inside the nose meaning the scars are made inside the nostrils. The benefit of a closed rhinoplasty is to avoid the scar. The negative is that you can have issues with being able to manipulate the nose as much as you want to. There’s a place for both open and closed rhinoplasties.
Ultrasonic Rhinoplasty
Moving further along, there are a couple of new terms for rhinoplasty. One is called piezo rhinoplasty or ultrasonic. They both kind of mean the same thing. Essentially for this type of rhinoplasty, there is a tool that is being used. The tool is an ultrasonic tool which basically removes bone but doesn’t remove soft tissue. So it’s nice in the fact that you can reshape bones and remove things under direct visualization.
Some doctors will use this for different parts of the nose. For me, I use it for every aspect of rhinoplasty. Some doctors will use it just for the bridge of the nose and then they’ll do traditional osteotomies on the side of the nose where they use a chisel or hammer. I like to see everything so I like that aspect of shaping the nose with everything under direct visualization.
I do everything completely with the ultrasonic tool, including the septum and other aspects of the nose.
Preservation Rhinoplasty
The final type of rhinoplasty is called a preservation rhinoplasty. And this term has come into vogue probably over the last four or five years. A preservation rhinoplasty is where typically different elements of the nose are preserved. It’s a great technique. A preservation rhinoplasty used to be called the swoop technique or a dropdown technique. In its current iteration, it is being called preservation rhinoplasty.
Essentially, there are different components that can be preserved. Number one, you could talk about preserving the soft tissue of the nose. That’s going to be done depending on what layer of dissection you work in.
The second element of a preservation rhinoplasty is going to be preserving the cartilage and not removing cartilage when you’re reshaping it and working more with suture techniques. And the final element of preservation rhinoplasty is preserving the bridge of the nose and having to drop down. That’s that swoosh technique or also known as the dropdown technique. There’s a place for this as well, and this is typically for patients who like the bridge shape on the outside but don’t like the bump and they want to drop things down.
Which Technique is best?
All of these techniques have a role in rhinoplasty. I use all these techniques to a different degree, depending on what the patient wants. My first step is to find out what the patient truly wants. From there, I discuss with the patient what the best technique for their goals are.
In conclusion there is no single technique that is best for every case or every patient although for me specifically traditional rhinoplasty plays less or a role because I prefer, for most cases, to perform an ultrasonic rhinoplasty.
