The Preservation Rhinoplasty: A New Rhinoplasty Revolution

Extract

Rhinoplasty surgery tends to evolve in generational epochs often associated with landmark publications and the simultaneous popularization of revolutionary surgical techniques. In 1978, Sheen published his monumental text Aesthetic Rhinoplasty which confirmed his status as the greatest rhinoplasty surgeon since Joseph.¹ Three critical concepts were summarized. First, rhinoplasty became a truly aesthetic operation which included preoperative analysis, operative planning, and surgical execution. Second, the reduction-only concept of Joseph was replaced with a balanced approach combining reduction and grafting in primary rhinoplasty. Third, the previously dismal results for secondary rhinoplasty were dramatically improved. Suddenly, the mark of a great rhinoplasty surgeon was no longer how quickly one could do a “nose job,” but rather the achievement of an attractive natural nose with normal function.

As the closed approach for rhinoplasty reached its apogee of influence, the open approach gained sudden popularity. Building on the work of Goodman,² Anderson,³ Daniel,^4,5 Gunter,⁶ and others, rhinoplasty surgeons quickly adopted the open approach. This revolution occurred for three reasons. First, the open approach offered better visualization for analysis, surgery, and teaching. Second, new operations were developed including tip suturing, advanced septal reconstruction, and midvault reconstruction which were either impossible or technically challenging via a closed approach. Third, the open approach shortened the learning curve for the less experienced surgeon and could be applied to a wider range of ethnic groups with good results. Rhinoplasty surgery enjoyed a wave of popularity and became one of the most frequently performed aesthetic surgical procedures.