Preservation rhinoplasty: what it is and who it suits

Preservation rhinoplasty aims to reshape the nose while keeping selected supporting structures intact. The Spare Roof technique is one approach within this field, focusing on the nasal bridge.

If you are considering rhinoplasty, terms such as “preservation”, “structural” and “ultrasonic” can be confusing. They describe different aspects of surgery. Here is how they fit together, what the evidence shows and why choosing an approach starts with an individual assessment.

Preservation rhinoplasty encompasses a range of approaches that reshape the nose while retaining specific anatomical structures. The aim is to tailor surgery to the individual, conserving tissue where this supports both the planned correction and nasal breathing.

It is not a single, standard operation. Different techniques preserve different structures, so two patients having preservation rhinoplasty may have quite different surgical plans.

The Spare Roof technique is a method of preserving the nasal dorsum, the bridge of the nose. It was described in a 2016 scientific paper by Professor Miguel Gonçalves Ferreira and colleagues.

The original technique focuses on retaining the cartilaginous roof of the middle third of the nose while reshaping the bridge. In straightforward terms, it aims to change the height and contour of this area while preserving structures that other approaches may separate and reconstruct.

Further variations have since been described. The Ferreira-Ishida technique, also known as Spare Roof B, was presented in 2022 and aims to retain the bony cap in selected anatomies. Patients do not need to choose between these variations themselves: their suitability is a clinical decision based on the nose being treated.

The main distinction is how the surgeon reshapes and supports the nose.

• Preservation techniques retain selected structures and their anatomical relationships where this allows the necessary correction.
• Structural techniques reshape and, where needed, rebuild or reinforce the framework, sometimes using cartilage grafts.

Neither approach is the best choice for every nose. Significant deformity or previous surgery may mean that support needs to be reconstructed. A surgical plan can also combine preservation principles in one area with structural work in another.

No. Preservation describes a surgical approach; ultrasonic technology describes a tool that may be used during surgery. Ultrasonic instruments work on bone and can form part of different surgical plans.

The two can therefore be used together. The instrument alone does not tell you everything about the operation or guarantee a particular result. Read more about ultrasonic rhinoplasty in Porto.

Your consultation is the starting point for deciding whether preservation techniques could be appropriate. The assessment considers:

• The shape of the bridge and the characteristics of the bone and cartilage.
• The position of the septum and any difficulty breathing through the nose.
• Skin thickness and the structure of the nasal tip.
• Asymmetry, previous injuries and any earlier nasal surgery.
• The changes you would like to make and whether your expectations are achievable.

A photograph or the name of a technique is not enough to establish suitability. An examination of the inside and outside of the nose helps the surgeon explain the options and the limits of treatment.

Published studies on the technique, including a randomised trial of 250 primary rhinoplasties, show good aesthetic and functional results under the conditions studied. They cannot, however, predict an individual result: suitability is always decided at the consultation.

The full history of the technique, its variants and the research are on the Spare Roof Technique page of Prof. Dr. Miguel Gonçalves Ferreira’s website (in Portuguese). The references for this article are listed below.

“Preservation” does not mean no swelling, no bruising or no recovery time. Healing depends on the work carried out, individual factors and postoperative care. The appearance of the nose continues to change over the following months.

As with any rhinoplasty, risks include bleeding, infection, changes in breathing, asymmetry and dissatisfaction with the appearance. Further treatment may be needed. Your surgeon should explain the risks and aftercare relevant to your own operation.

Our rhinoplasty case gallery illustrates a range of treated cases. Other patients’ photographs cannot predict your outcome.

Is preservation rhinoplasty always a closed procedure?

No. “Open” and “closed” describe how the surgeon accesses the nasal structures. “Preservation” describes how selected structures are managed. These are separate considerations within the surgical plan.

Can the Spare Roof technique improve breathing?

Breathing should be assessed as part of the consultation. Any improvement depends on the cause of obstruction and whether treatment of the septum, nasal valves or other structures is indicated. The name of a technique alone does not tell you whether breathing will improve.

Can it be used for revision rhinoplasty?

Previous surgery can change the anatomy and support of the nose. What can be preserved depends on the remaining structures and the correction required. Some revision cases need reconstruction or reinforcement.

Does it guarantee a natural-looking result?

A nose that sits comfortably with the rest of the face is an aim of planning, but no technique guarantees a particular appearance. Anatomy, healing and the limitations of surgery all influence the outcome.

How do I know which approach is right for me?

At your consultation, the surgeon will examine the form and function of your nose, listen to your concerns and explain your options. Understanding the proposed plan, its possible benefits and its limitations is more useful than choosing by technique name alone.

• Ferreira MG et al.. Spare Roof Technique: A Middle Third New Technique. Facial Plastic Surgery, 2016.
• Ferreira MG et al.. Spare Roof Technique Versus Component Dorsal Hump Reduction: A Randomized Prospective Study in 250 Primary Rhinoplasties, Aesthetic and Functional Outcomes. Aesthetic Surgery Journal, 2021.
• Ferreira MG et al.. Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping. Plastic and Reconstructive Surgery, 2022.
• NHS. Nose reshaping (rhinoplasty): general information on recovery and risks.

At Clínica do Nariz e Face, you can book a consultation with Professor Miguel Gonçalves Ferreira to discuss the appearance and function of your nose and the approaches that may suit your needs.

Find out more about rhinoplasty in Porto or book a consultation in Porto or Braga.

Need help arranging an appointment? Contact our team on WhatsApp or call +351 934 187 135.

This article is for general information and does not replace a medical consultation. The choice of surgical technique requires an individual assessment.