Why Was Let-Down Rhinoplasty Born?

Let-Down Rhinoplasty Arose from a Need

Whether you have rhinoplasty with the closed or the open method, if your nasal bridge is too prominent it has to be reduced. At least, our thousands of years of aesthetic sense do not like humped noses.

In the evolution of rhinoplasty we have removed the nasal hump with many methods. Sometimes we scored the bone with special chisels so that it broke in a straight line; sometimes we removed the bone of the nasal bridge using vibration with a piezo saw, sometimes with a hand saw and sometimes with lasers (that did not really catch on).

We are constantly searching, and the reason is this. Now imagine: you have chosen a method and removed the excess bone of the nasal bridge, and it has turned out wonderfully – perfectly straight, flawless. Sometimes it is slightly uneven, and we correct that with a kind of rasping. One way or another we reach the shape we want.

So what is the problem? Do you know how our body behaves at this point? “Uh-oh, I've been injured, I must heal.” And so, along the straight line of the bone on the nasal bridge we have carefully designed to be smooth, sprouts form as the bone tries to heal, like shoots growing from the trunk of a felled tree.

These sprouts can sometimes reach a level that spoils the shape. Or these cut bone edges sometimes leave small palpable separations on the nasal bridge (sometimes an open roof), due to excessive fluid retention in the tissue between them, minor injuries the patient did not notice, or simply because the bone is thick. In very thin-skinned people this can be much more visible.

Yet the design of the nose in creation is truly perfect, and we still cannot reach that perfection. There is a nasal bridge in the middle that we do not want to spoil, but because we find it a little too high, we have to remove it.

And thanks to Yves Saban, who instilled a wonderful idea in us: if we like the nasal bridge and our only problem is its height, why not lower it without disturbing its structure?

If a table you love is too tall, we can lower it by cutting the ends of its legs without spoiling its beauty, can't we? This idea spread quickly all over the world, and in some places it began to be called preservation rhinoplasty.

When let-down or preservation rhinoplasty is also performed closed, it represents an excellent rhinoplasty technique by today's standards of plastic surgery. To me, it is something like fully comprehensive insurance.

Is every case suitable? Of course not. I will discuss this at length in another article. For now, stay with let-down.