Preservation rhinoplasty keeps the natural dorsal bone-cartilage continuity intact and lowers the bridge by repositioning, not by removal and reconstruction. It produces a more natural dorsum, gentler recovery, and a result that ages better — when applied to the right anatomy.
- Definition: what preservation rhinoplasty actually means
- Preservation vs traditional structural rhinoplasty
- The four main preservation variants (push-down, let-down, LSR, HSR)
- Who is a good candidate?
- The surgical process step by step
- Recovery and final result
- Cost in Istanbul
- Frequently asked questions
Definition: what preservation rhinoplasty actually means
In a classical (structural) rhinoplasty, the surgeon removes the dorsal hump — meaning the bony and cartilaginous prominence of the bridge — and then reconstructs the nasal roof, often with cartilage grafts and sutures. The result is good when performed well, but the dorsal aesthetic lines (the smooth highlights running from the medial brow down each side of the nose) have been disassembled and rebuilt.
In a preservation rhinoplasty, the surgeon does not remove the hump. Instead, support is taken away from beneath the dorsum — by trimming part of the septum and releasing the lateral bony attachments — and the entire dorsal bone-cartilage unit is then lowered as a single, continuous block. Nothing on top is altered. The natural anatomy that defines the patient's signature dorsum stays intact; it simply sits lower.
This is the technique's defining feature: the dorsum is preserved, not reconstructed.
Preservation vs traditional structural rhinoplasty
| Feature | Preservation | Structural |
|---|---|---|
| Dorsal hump | Lowered (kept intact) | Removed |
| Dorsal aesthetic lines | Preserved | Reconstructed |
| Bony-cartilaginous vault continuity | Maintained | Disassembled |
| Visible irregularities long-term | Less likely | Possible (graft visibility) |
| Cartilage grafts | Rare | Common |
| Approach | Most often closed | Open or closed |
| Best for | Smooth/moderate humps, natural-result patients | Severe deformities, wide reconstructions |
The four main preservation variants
"Preservation rhinoplasty" is an umbrella term. Dr. Erdal selects from four main techniques depending on the patient's anatomy:
1. Push-down
The bony pyramid is impacted downward without removing any bone. Best for small dorsal humps with a relatively narrow bony base.
2. Let-down
A small wedge of bone is removed at the base of the lateral nasal walls so the entire dorsal block can be lowered further than push-down allows. Best for medium and larger humps where simple impaction would leave the bridge too wide.
3. Low septal resection (LSR)
The dorsal block is lowered by resecting a strip from the septum just above the K-area (the keystone region). Provides excellent control of the supratip area.
4. High septal resection (HSR)
The septal strip is removed higher up, very close to the under-surface of the dorsum. Useful in selected anatomies. Dr. Erdal has published technique refinements specifically on closed-approach HSR (Facial Plast Surg 2023).
Who is a good candidate?
Preservation works particularly well for patients with:
- A smooth, organic dorsal hump (not a sharp pointed hump)
- Reasonable skin thickness — neither very thick nor very thin
- A primary case (no prior surgery) or a revision where the dorsum was not previously over-resected
- An aesthetic preference for natural rather than dramatic change
- A request to keep the dorsal aesthetic lines of their face
Preservation may be less ideal — or require careful planning — for:
- Very large, prominent dorsal humps (sometimes still possible with let-down + HSR/LSR)
- Severely deviated noses requiring asymmetric correction
- Post-traumatic deformities with disrupted bony anatomy
- Patients who specifically want a dramatic, sculpted look
For an in-depth checklist, read our guide on the 7 anatomical signs you may be a preservation rhinoplasty candidate.
The surgical process, step by step
1. Consultation and photo analysis
You send three photos — front, profile, and three-quarter view. Dr. Erdal personally analyses your anatomy: hump size, dorsal continuity, septal length, tip support, skin thickness, and breathing function. Within 24 hours you receive a personalised assessment with technique recommendation.
2. Pre-operative day in Istanbul
You arrive at Istanbul Airport and are met by VIP transfer to Antwell Suites İstanbul. Pre-operative bloodwork and anaesthesia clearance are completed at the JCI-accredited hospital.
3. Surgery (2–3 hours)
Under general anaesthesia, Dr. Erdal performs the closed-approach preservation technique chosen for your anatomy. Tip refinement, alar adjustment, and septoplasty (if indicated for breathing) are integrated into the same operation. No external scars.
4. First 7 days
External splint protects the bridge. One night hospital observation, then suite-style hotel recovery. WhatsApp access to Dr. Erdal throughout.
5. Splint removal and fly home
Day 7 splint removal, fly home day 7–14, follow-up via WhatsApp and online consultations at 1, 3, 6, and 12 months.
Recovery and final result
Preservation patients typically experience less prolonged supratip swelling than structural patients because the soft-tissue envelope drainage pathways are less disrupted. The dorsum looks natural from the moment the splint comes off, and continues to refine subtly as deeper edema resolves over the following months. See our full week-by-week recovery timeline.
Cost in Istanbul
Dr. Erdal's all-inclusive VIP package covers surgery, JCI-accredited hospital, board-certified anaesthesia, suite-style hotel for 7 nights at Antwell Suites İstanbul, all VIP transfers, and a 12-month follow-up programme — with no hidden fees. Pricing is personalised after photo review. See cost & packages for the full breakdown.
Frequently asked questions
Yes. The result is permanent. Because the natural dorsum is preserved as a single block, the long-term aesthetic stability is excellent.
Yes. In fact, septoplasty is integral to most preservation techniques (the septal resection itself is what allows the dorsum to drop). Combining functional septoplasty for breathing with preservation rhinoplasty in a single operation is routine.
No. The defining feature of preservation rhinoplasty is naturalness — the dorsal aesthetic lines belong to your face, not to a generic surgical template.
Closed (endonasal). All incisions are inside the nostrils. There is no external columellar scar.
They are unrelated concepts. Ultrasonic rhinoplasty refers to the instrument used to shape bone (a piezoelectric device). Preservation rhinoplasty refers to the philosophy of keeping the dorsum intact. The two can be combined or used independently.
