Noses

Preservation Rhinoplasty: A Complete Guide

March 6th 2025 · Updated on 27 September 2026

Updated on 27 September 2026 • Reviewed by Dr. Gustavo Sordo, plastic surgeon

Rhinoplasty is one of the most requested plastic surgeries worldwide. Traditionally, this procedure has focused on changing the shape and contour of the nose, but in recent years an innovative technique known as preservation rhinoplasty has emerged. This approach seeks to maintain the original nasal structure, while improving aesthetics and functionality. Join us to discover the details of this innovative technique.

What is preservation rhinoplasty?

Preservation rhinoplasty, also known as preservation rhinoplasty, is one of the most modern and advanced rhinoplasty techniques . It consists of correcting the shape of the nose while preserving (hence its name) the nasal bridge, cartilage, and ligaments as much as possible.

It is a surgical technique for reshaping the nose that aims to preserve as much of its natural structure as possible, such as cartilage, bone, and ligaments, rather than removing or significantly altering them. Unlike traditional rhinoplasty, where parts of the nasal bridge (the "hump") are typically cut and removed to change its shape, this technique adjusts the nose more subtly, for example, by lowering the intact bridge using methods like the "push-down" or "let-down" technique. The goal is to achieve a natural result with less tissue trauma, a faster recovery, and potentially fewer complications.

Before and after photos

Here are some examples of before and after photos taken recently in the operating room.

What type of patients is it recommended for?

This technique is not suitable for all rhinoplasty cases; it will depend on the anatomy of your nose and your expectations for the result.

Preservation rhinoplasty is recommended for patients seeking subtle changes, those who prefer a natural - looking result that doesn't reveal the surgical intervention. It's also suitable for those with minor deformities, such as asymmetries or slight deviations of the nose, who are looking for subtle corrections. Those with breathing problems who wish to improve nasal function without drastically altering its shape also have this rhinoplasty option. If you are considering this type of surgery, the specialist will have the final say after conducting the necessary evaluation.

Benefits  

Preservation rhinoplasty offers multiple benefits that make it an attractive option:

Less trauma

Surgical trauma is reduced by avoiding the removal of nasal structures. With less bruising and swelling, the patient will be less in pain.

Faster recovery

This procedure is less invasive than traditional rhinoplasty, allowing for a faster recovery and fewer complications.

natural results

The technique allows the original appearance of the nose to be maintained, achieving aesthetically pleasing and natural results, avoiding the “operated nose” result that many do not desire.

Lower risk of complications

By preserving the nasal structure, the risk of post-surgical problems, such as scarring or deformities, is reduced.

Difference between structural ultrasonic rhinoplasty and preservation ultrasonic rhinoplasty

Both rhinoplasty procedures, ultrasonic rhinoplasty and ultrasonic preservation rhinoplasty, are performed at our clinic using ultrasound. However, there is a difference, which we explain below. The chosen technique depends on each patient's individual needs, and often, in the operating room, after examining the nasal structure before the procedure, we can determine which technique is best.

However, here we tell you:

How is it the procedure?

Typical steps of surgery are described below:

Preoperative consultation

A thorough evaluation of the nose is carried out and the patient's expectations and wishes are discussed. Digital simulations are performed to visualize possible results. If necessary, the doctor will request a CT scan.

Procedure

Depending on the agreement between the patient and the specialist, local or general anesthesia is administered. Then the surgical procedure is carried out, which is divided into two stages:

• Impaction of the bony dorsum (Push Down technique) (Let Down): The Push Down technique allows the height of the back to be reduced without altering its upper structure. It is performed through a closed rhinoplasty approach, avoiding direct manipulation of the nasal dorsum. A complete osteotomy is performed around the nasal pyramid, causing a fracture that facilitates lowering of the nasal dorsum by impaction.
•  Preservation of the ligamentous, muscular and cartilaginous apparatus:
  Surgical maneuvers are implemented here to promote the opening of the nasal valves, minimizing cartilage and ligament resections as much as possible. Preservation of the ligaments contributes to a natural positioning of the nasal tip.

Postoperative

At the end of the surgical procedure, splints or bandages are placed to stabilize the nose and the patient is given instructions on postoperative care. It is important to follow these instructions to the letter, since the success of the surgery will depend on this.

Hybrid preservation: how we do it

In practice, most of the noses we operate on don't fit neatly into either pure preservation or pure structural rhinoplasty: what we do is hybrid preservation . That is, we preserve the dorsum and the entire ligamentous apparatus whenever the anatomy allows, and at the same time, we structure the tip with autologous grafts when necessary. The great practical advantage is that, by not using septal cartilage on spreader grafts to reconstruct a dorsum we haven't opened, much more material remains available to support the tip , which is where strength is truly lost over the years.

There isn't a single technique for preservation, and the choice depends on the structure of each nose. In cases of axial deviation —a nose that leans entirely to one side, like the Leaning Tower of Pisa, because one lateral wall is shorter than the other—we use SPQR ultrasonic hybrid preservation , which allows us to surgically shorten the longer lateral wall to even it out and pivot the nose toward the center of the face (Çakır et al., 2023, Facial Plast Surg Clin North Am ). When the bone is straight but the deviation is located in the keystone area and the nose is already small or has a low radix, where further size reduction is not desirable, we use the Ferreira-Nakamura technique , which combines subdorsal osteotomies with a low strip (described by Fernando Nakamura at the Global Masters of Rhinoplasty, Rio de Janeiro, 2025).

For the tip, we work with a double vertical septal extension graft to which we add a triangular horizontal component at its anterior end—what we call the Armadillo Tip (Froilán Páez)—which provides support precisely at the mid-crus of the alar cartilages: the most neglected area of ​​the nasal tip and where the most projection is lost over time. All the bone work is done with ultrasonic (piezo) technology , which allows us to sculpt the bone without a hammer or chisel, with significantly less trauma to the soft tissues and, therefore, less bruising and inflammation in the postoperative period.

That's why we insist so much that the surgeon master all three techniques—preservation, structural, and hybrid—: those who only know one technique end up forcing all noses into that one. And a maxim we always repeat in consultations: wherever the septum goes, the nose follows ; without a straight and well-supported septum, no dorsal technique will maintain the result over time.

How much does a preservation rhinoplasty cost?

In Spain, the price of preservation rhinoplasty can vary considerably depending on several factors, but generally ranges from €9.000 to €20.000 . It's important not to choose the cheapest option, but to select a specialist with experience and a good reputation. Don't skimp on price; after all, your nose will be with you for life.

Risks in a preservation rhinoplasty

All surgical procedures carry risks, and preservation rhinoplasty is no exception. Fortunately, these risks are less common and less severe than those associated with traditional rhinoplasty . Possible risks include bleeding during or after surgery, infections, unexpected results (sometimes requiring additional surgery), and, very rarely, complications related to breathing.

We reiterate the importance of choosing a surgeon with proven experience in preservation rhinoplasty, in order to minimize the risks mentioned and ensure the best possible results.

Recovery and postoperative care

Recovery after preservation rhinoplasty is usually quicker compared to traditional rhinoplasty. You should still carefully follow your surgeon's recommendations to ensure a proper recovery. Some post-operative care includes:

Rest

It is essential to rest during the first few days and avoid intense physical activities during the first few weeks to avoid the possibility of nosebleeds.

cold compresses

Applying cold compresses helps reduce swelling and discomfort. Ice is always recommended after facial surgery, as it not only reduces inflammation but also acts as a local anesthetic.

Pharmaceutical products

Following medical advice on the use of painkillers and anti-inflammatories will help reduce pain and swelling. Antibiotics will prevent infection.

Incision care

Keeping the incisions clean and dry is essential to prevent infection and promote good healing.

Follow-up appointments

It is important to attend follow-up appointments with your surgeon to monitor your recovery.

How long does it take to see the final result?

Although the initial results of preservation rhinoplasty are usually visible almost immediately, swelling takes weeks to subside. During the first two weeks, the swelling gradually decreases, and the inflammation continues to reduce until about six months , at which point the final result can be considered.

Can preservation rhinoplasty be combined with other surgeries?

Yes, preservation rhinoplasty can be combined with other cosmetic procedures, such as liposuction, breast augmentation, or blepharoplasty, among others. The most daring patients undergo simultaneous surgeries, provided the surgeon assesses the feasibility and potential risks of combining procedures.

You might be interested in: liposuction before and after.

What should I consider before performing the procedure?

It is wise to consider several aspects before undergoing preservation rhinoplasty. Let's take a look:

• Realistic expectations: You must be clear about your expectations regarding the results. Know and understand that surgery will not solve all problems related to personal image or self-esteem. Discussing this during your consultation with a qualified surgeon will help you in this regard.
• General health: Your overall health is important, the surgeon should be aware of any pre-existing medical conditions.
• Answer these two questions: Are you willing and committed to following all pre- and post-operative instructions to ensure a successful recovery? Do you have someone to help and support you in the early post-operative days? These are important points to consider before embarking on this adventure.
• Financing: Evaluate the price and financing options available to you.
• Investigation: Make sure you choose a plastic surgeon with experience in preservation rhinoplasty, ask for recommendations, the experiences of those who have undergone the same procedure are valuable.

Finding an empathetic specialist who inspires confidence from day one is no small feat. At Dr. Gustavo Sordo's Plastic Surgery Clinic in Madrid , we are experts in rhinoplasty procedures and ultrasonic rhinoplasty in Madrid , specializing in both preservation and structural rhinoplasty.

Dr. Sordo, plastic surgeon in Madrid[Name of clinic/clinic] is dedicated to offering personalized solutions for each patient, with an aesthetic and functional focus. [Name of clinic/clinic] is considered [to be a leading/specialized/innovative/etc.] specialized in rhinoplasty, has more than 20 years of experience in the aesthetic field and has the most advanced equipment in medical technology.

We recommend you take a look at all their before and after rhinoplasty cases.

Conclusion 

Preservative rhinoplasty is a promising technique that offers patients the opportunity to improve the aesthetics and functionality of their nose without compromising its natural structure. In the hands of the right surgeon, this intervention can transform not only the physical appearance, but also the patient's confidence and self-esteem.