Bianca Clinic’s approach to aesthetic and functional rhinoplasty focuses on achieving natural beauty while preserving and enhancing nasal function. We prioritize maintaining the nose’s structural integrity to ensure both a harmonious appearance and proper breathing. Personalized surgical plans are developed for each patient using advanced techniques to meet their unique goals.
What is Preservation Rhinoplasty?
Preservation Rhinoplasty (PR), introduced around 2018 by Rollin K. Daniel and Baris Cakir, focuses on reshaping the nose without disrupting its original structure. Since late 2020, Western practices have shifted from traditional structure rhinoplasty to a combination of structure and preservation techniques. The surgeons at Bianca Clinic have adopted this hybrid approach to suit Japanese anatomy and uses cutting-edge methods to achieve each patient’s ideal nose, with experience operating on diverse ethnicities.
Our Counseling / Consultation
To achieve ideal results, thorough counseling is essential. Patients are encouraged to bring reference images to help communicate their goals. The clinic places great importance on preserving nasal structure while enhancing both function and aesthetics. Consultations are conducted using Bianca Clinic’s original counseling diagram for personalized planning.
During the consultation, the doctor carefully examines the nose through palpation and internal inspection using a nasal speculum. This helps determine nasal mobility and identify any structural issues. Based on these findings, a personalized surgical plan is developed, choosing the best method from a wide range of options to match the patient’s ideal outcome.
About the Nasal Structure
The nasal support structure consists of major and minor cartilages and the nasal bone. Many Asian patients have thicker skin and underdeveloped cartilage, which affects nasal shape. Bianca Clinic customizes surgical approaches—removing or grafting tissue as needed—while preserving function. The design is based on each person’s anatomy, using advanced concepts like Cakir’s “tip polygon” to guide reconstruction.
Nasal Aesthetics
In the preservation rhinoplasty performed at Bianca Clinic, nasal aesthetics are analyzed by dividing the nose into “polygon” segments. Each segment is assessed and reshaped through bone or cartilage modification to match the patient’s desired nasal shape, which is discussed in detail during consultation.
Design Philosophy
Our focus is on creating a natural and beautiful line that flows smoothly from the nasal dorsum to the tip. Simply using an implant (prosthesis) to straighten the nasal bridge can sometimes result in an unnatural appearance.
By performing osteotomy to narrow and slim the nasal width, reducing protrusions such as humps, and refining the nasal tip to be slightly elevated, we aim to create a smooth, elegant line—similar to the gentle slope of a ski jump. Achieving this requires advanced surgical skill and precision.
Nasal Dorsal Line
In recent years, the “upturned nose” or “up-nose” — once mainly preferred by Westerners — has become popular among Asian patients too. However, achieving a natural result requires designing the nasal tip at an anatomically appropriate angle, using preoperative CT imaging to assess overall facial balance. Since the nose significantly impacts facial impression, consultations should be done carefully with a trusted, skilled surgeon.
CT scan
To refine the nasal structure, bone-cutting techniques are often necessary. At Bianca Clinic, high-resolution CT scans with 0.5 mm slices are used to create precise 3D images for surgical planning. This data helps visualize the nasal septum cartilage and allows for accurate procedures like septal extension, ensuring a well-balanced nasal design.
Surgical tools
Rhinoplasty requires the use of 40 to 50 different surgical instruments. To execute the surgical plan precisely, Bianca Clinic employs a wide range of these tools. For preservation rhinoplasty in particular, the clinic uses specially ordered instruments from countries like Turkey and Germany, tailored to advanced and delicate techniques.
Surgical Procedure
In preservation rhinoplasty, an incision is made at the columella to access the alar cartilage. Dissection is performed under the cartilage and bone membranes to expose necessary structures while minimizing damage to blood vessels and surrounding tissue. This technique helps reduce swelling and shortens recovery time.
Septoplasty
In septoplasty, cartilage from the nasal septum is harvested for use in nasal tip extension. For patients requiring hump removal, protruding septal cartilage is trimmed. A specialized suction dissector, commonly used in ENT procedures, allows for the safe collection of sufficient cartilage for grafting.
Bone osteotomy procedures
In bone osteotomy procedures, Bianca Clinic uses advanced techniques such as the “Pushdown Technique” (presented at PRS Korea 2021) to narrow the nasal bridge without disrupting the bone structure. For patients with a dorsal hump, excess nasal bone is carefully reduced. Preoperative CT imaging helps plan precise cuts for a refined and slim nasal profile using multiple bone-cutting strategies.
Septal Extension & Nasal Tip Plasty
Bianca Clinic enhances nasal tip projection using septal extension and tip refinement based on Cakir’s Polygon concept. This involves reshaping flat, rounded cartilage into structured angles using suture techniques. Excess cartilage is trimmed, and the ideal nasal tip angle is set during septal extension to achieve a refined, lifted tip that complements the patient’s facial features.
Graft Materials
In revision rhinoplasty or cases of severely short noses, rib cartilage is used as graft material. For dorsal augmentation using the patient’s own tissue, options include fascia from the temple or ear cartilage. When carefully crafted and combined with osteotomy techniques, autologous grafts can achieve results equal to or better than implants.
Postoperative recovery time
To minimize downtime, dissection is performed beneath the cartilage and bone membranes to reduce intraoperative damage to blood vessels and soft tissue. Postoperatively, silicone splints are placed inside the nose, and an external splint is applied to gently compress and control swelling. In some cases, swelling is so minimal that it’s barely noticeable a week after splint removal.
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