Trial, Error, and Expertise: My Evolution Through Structural and Preservation Rhinoplasty Techniques

Abstract

Introduction

Rhinoplasty continues to evolve, with small technical refinements yielding significant aesthetic and functional gains. This article reflects on nearly two decades of surgical experience, focusing on the balance between structural support and anatomical preservation.

Objectives & Hypotheses

The study aims to evaluate the effectiveness of combining preservation and structural techniques in closed rhinoplasty. It is hypothesized that this hybrid approach enhances surgical consistency and long-term outcomes.

Study Design

A retrospective, experience-based review of a single surgeon's rhinoplasty evolution is presented, highlighting technical transitions and refinements over time.

Methods

Key refinements include Pitanguy ligament preservation, controlled mucosal resection, scroll area preservation, dual-plane dissection, rim flap techniques, subdomal grafting, and wide subperiosteal dissection. Open and closed approaches were selected based on anatomical features and case complexity.

Results

The adoption of preservation principles in closed rhinoplasty led to improved tip definition, supratip contour control, and dorsal stability. Wide dissection techniques enhanced skin redraping and minimized postoperative complications. Combining structural support with anatomical preservation yielded more predictable outcomes in primary cases.

Conclusion

Closed rhinoplasty techniques that integrate both preservation and structural strategies offer a reproducible and refined surgical result. Continuous evaluation and adjustment of technical details are key to optimizing long-term functional and aesthetic success.

Keywords

rhinoplasty - preservation rhinoplasty - closed rhinoplasty

Declaration of GenAI Use

During the writing process, the authors used ChatGPT to improve the grammar of the article. The authors have thoroughly reviewed and edited the text and take full responsibility for its content.

Publication History

Accepted Manuscript online:
23 June 2025

Article published online:
18 July 2025

• References

• 1 Sheen JH, Sheen AP. Aesthetic Rhinoplasty. 2nd ed.. Thieme; 1998
• 2 Cakır B. Aesthetic septorhinoplasty (2. baskı). Springer; 2021
• 3 Cakir B, Oreroğlu AR, Doğan T, Akan M. A complete subperichondrial dissection technique for rhinoplasty with management of the nasal ligaments. Aesthet Surg J 2012; 32 (05) 564-574
• 4 Tebbetts JB. Primary Rhinoplasty: A New Approach to the Logic and the Techniques. Mosby Elsevier; 2008
• 5 Finocchi V, Nele G, Çakır B. Dissection, drains and dead space closure: the 3D's to improve patient comfort and reduce early bruising and late fibrosis in rhinoplasty. Aesthetic Plast Surg 2020; 44 (05) 1929-1934
• 6 Daniel RK, Palhazi P, Saban Y, Çakır B. , eds. Preservation Rhinoplasty. 3rd ed.. Septum; 2022
• 7 Daniel RK, Pálházi P. Rhinoplasty: An Anatomical and Clinical Atlas. Springer; 2018
• 8 Kosins AM, Daniel RK. Decision Making in Preservation Rhinoplasty: A 100 Case Series With One-Year Follow-Up. Aesthet Surg J 2020; 40 (01) 34-48
• 9 Denenberg S. . Facial Surgery Center; 2025 . Accessed June 23, 2025 at: https://www.facialsurgery.com
• 10 Çakır B, Küçüker İ, Aksakal İA, Sağır HÖ. Auto-rim flap technique for lateral crura caudal excess treatment. Aesthet Surg J 2017; 37 (01) 24-32
• 11 Neves JC, Zholtikov V, Cakir B, Coşkun E, Arancibia-Tagle D. Rhinoplasty dissection planes (subcutaneous, sub-SMAS, supra-perichondral, and sub-perichondral) and soft tissues management. Facial Plast Surg 2021; 37 (01) 2-11
• 12 Eskalen A, Cakir B. A suture technique for nasal tip support: ‘neo-interdomal ligament suture’. Aesthetic Plast Surg 2024; 49 (09) 2439-2445
• 13 Dosanjh AS, Hsu C, Gruber RP. The hemitransdomal suture for narrowing the nasal tip. Ann Plast Surg 2010; 64 (06) 708-712
• 14 Ozmen S, Eryilmaz T, Sencan A. et al. Sliding alar cartilage (SAC) flap: a new technique for nasal tip surgery. Ann Plast Surg 2009; 63 (05) 480-485
• 15 Finocchi V. . SPQR technique. Preservation Rhinoplasty Meeting, 2019 , Nice, France