Preservation Rhinoplasty in Egypt — Dr. Mohamed El-Assal
Preservation rhinoplasty represents one of the most significant advances in nasal surgery over the past decade. Unlike conventional rhinoplasty techniques that involve extensive cartilage and bone removal followed by reconstruction, preservation rhinoplasty reshapes the existing nasal framework while maintaining its structural integrity wherever possible.
The result is a more natural appearance, and in selected cases may contribute to reduced post-operative swelling — with a recovery profile that allows the nose to settle more predictably — all while preserving the patient’s individual facial identity.
Why Doesn't Preservation Surgery Mean "Less" Surgery?
Preservation rhinoplasty does not mean a smaller or simpler procedure. It means preserving as much of the nose's original anatomical structure as possible when it is safe and suitable for the case. This approach aims to achieve a balanced result that respects the original anatomy and preserves or improves breathing function as needed — without being suitable for every patient or every type of deformity.
Why Isn't It Suitable for Everyone?
✔ Not every hump is suitable for this approach — some very large humps require structural intervention.
✔ Not every deviation is suitable — severe deviations may require more extensive reconstruction.
✔ Not every primary surgery is suitable — some primary cases require radical modification from the outset.
✔ Not suitable for most complex revision cases — structural changes from previous surgery often necessitate a structural approach.
✔ Not suitable if preserving the natural structure would negatively affect result quality or nasal function.
The surgeon determines the suitability of the technique after clinical examination — not based on the patient's preference or the technique's name.
✔ Not every deviation is suitable — severe deviations may require more extensive reconstruction.
✔ Not every primary surgery is suitable — some primary cases require radical modification from the outset.
✔ Not suitable for most complex revision cases — structural changes from previous surgery often necessitate a structural approach.
✔ Not suitable if preserving the natural structure would negatively affect result quality or nasal function.
The surgeon determines the suitability of the technique after clinical examination — not based on the patient's preference or the technique's name.
What Is Preservation Rhinoplasty?
Preservation rhinoplasty is a modern surgical approach that maintains the mucoperichondrial envelope and nasal ligament system as an intact unit, rather than disrupting them as in traditional techniques.
This technique is particularly effective for:
• Dorsal hump reduction via lowering rather than resection and reconstruction
• Nasal tip refinement
• Mild to moderate nasal deviation
• Harmonizing overall nasal proportions with facial balance
The core principle: "If the aesthetic goal can be achieved while preserving structure, preservation is the superior choice."
This technique is particularly effective for:
• Dorsal hump reduction via lowering rather than resection and reconstruction
• Nasal tip refinement
• Mild to moderate nasal deviation
• Harmonizing overall nasal proportions with facial balance
The core principle: "If the aesthetic goal can be achieved while preserving structure, preservation is the superior choice."
How Is the Suitability of the Preservation Technique Determined?
✔ Shape of the nasal hump.
✔ Bridge height.
✔ Integrity of the nasal roof.
✔ Quality and width of the nasal bones.
✔ Skin thickness.
✔ Current breathing function.
✔ Extent of reconstruction needed.
✔ Patient's realistic expectations and goals.
This integrated assessment is what determines the suitability of the preservation approach for each individual case.
✔ Bridge height.
✔ Integrity of the nasal roof.
✔ Quality and width of the nasal bones.
✔ Skin thickness.
✔ Current breathing function.
✔ Extent of reconstruction needed.
✔ Patient's realistic expectations and goals.
This integrated assessment is what determines the suitability of the preservation approach for each individual case.
Dr. Mohamed El Assal's Training with Prof. Yves Saban
Dr. Mohamed El Assal received advanced training with Prof. Yves Saban, one of the foremost pioneers of Preservation Rhinoplasty worldwide, and applied the principles of this school of thought to case selection and to preserving natural anatomy and nasal function whenever possible.
This training did not translate into using the preservation technique on every patient, but rather into a precise evaluation methodology: determining when the anatomical structure is genuinely a good candidate for preservation, and when a structural or hybrid approach is the safer, more effective choice.
This training did not translate into using the preservation technique on every patient, but rather into a precise evaluation methodology: determining when the anatomical structure is genuinely a good candidate for preservation, and when a structural or hybrid approach is the safer, more effective choice.
What Are We Trying to Preserve in This Surgery?
✔ The nasal roof.
✔ Supporting ligaments.
✔ The nose's original cartilage.
✔ Breathing function.
✔ The natural support of the nasal framework.
✔ The natural anatomical relationships between the nose's components.
✔ Supporting ligaments.
✔ The nose's original cartilage.
✔ Breathing function.
✔ The natural support of the nasal framework.
✔ The natural anatomical relationships between the nose's components.
What Is the Difference Between Preservation and Structural?
| Preservation | Structural |
|---|---|
| Preserves natural structure when possible | Rebuilds the framework when needed |
| For anatomically suitable cases | For cases requiring more extensive reshaping |
| Selection depends on the case | Selection depends on the case |
| A surgical tool used in the appropriate case | A surgical tool used in the appropriate case |
Are the Results More Natural?
The preservation technique may help achieve natural results and preserve original structure in selected cases, when anatomically suitable. This does not mean other techniques cannot also achieve natural results; the decisive factor in result naturalness is the precision of surgical planning and how well the chosen technique suits the case — not the type of technique itself. A natural result depends more on how well the technique fits the case than on the name of the technique itself.
Why Does the Plan Differ Between Patients?
✔ Shape of the nasal hump.
✔ Bridge height.
✔ Bone integrity.
✔ Cartilage quality.
✔ Extent of reconstruction needed.
✔ Presence of functional issues such as septal deviation or weak nasal valves.
These factors combined — not a single factor — determine the individualised surgical plan for each patient.
✔ Bridge height.
✔ Bone integrity.
✔ Cartilage quality.
✔ Extent of reconstruction needed.
✔ Presence of functional issues such as septal deviation or weak nasal valves.
These factors combined — not a single factor — determine the individualised surgical plan for each patient.
When Don't We Use Preservation?
✔ When major structural reconstruction is needed.
✔ In some complex revision cases.
✔ In some severe deformities.
✔ When the actual anatomical structure does not safely allow preservation.
✔ When achieving a stable result requires complete reconstruction of the nasal framework.
In these cases, a structural approach or a hybrid technique combining elements of both is preferred, serving the long-term safety of the result and nasal function.
✔ In some complex revision cases.
✔ In some severe deformities.
✔ When the actual anatomical structure does not safely allow preservation.
✔ When achieving a stable result requires complete reconstruction of the nasal framework.
In these cases, a structural approach or a hybrid technique combining elements of both is preferred, serving the long-term safety of the result and nasal function.
Why We Don't Rely on Photos Alone?
Determining the suitability of the preservation technique cannot rely on photographs alone, as assessing the integrity of the nasal roof, ligament strength, and cartilage quality requires direct, precise clinical examination. Photographs help form an initial impression of the case, but the final surgical decision is always based on direct examination with Dr. Mohamed El Assal.
Who Is the Ideal Candidate?
Preservation rhinoplasty is particularly suited for:
• Patients with a visible dorsal hump seeking a natural result
• Those wanting subtle refinements without radical nasal change
• Patients with a good underlying nasal framework worth preserving
• Cases not requiring major structural reconstruction
It may not be the ideal choice for:
• Cases requiring significant structural modification
• Noses with major cartilage defects or severe deformities
• Complex revision rhinoplasty cases
• Patients with a visible dorsal hump seeking a natural result
• Those wanting subtle refinements without radical nasal change
• Patients with a good underlying nasal framework worth preserving
• Cases not requiring major structural reconstruction
It may not be the ideal choice for:
• Cases requiring significant structural modification
• Noses with major cartilage defects or severe deformities
• Complex revision rhinoplasty cases
What to Expect?
Swelling & bruising: Typically less than with conventional techniques, resolving gradually over the first weeks.
Splint removal: One week post-surgery.
Social return: Two to three weeks in most cases.
Final result: Forms gradually. Key features may become apparent earlier than with traditional approaches, with full resolution by 12 months.
Important medical note: Results vary between patients and depend on multiple factors including skin thickness, cartilage characteristics, and aesthetic goals.
Splint removal: One week post-surgery.
Social return: Two to three weeks in most cases.
Final result: Forms gradually. Key features may become apparent earlier than with traditional approaches, with full resolution by 12 months.
Important medical note: Results vary between patients and depend on multiple factors including skin thickness, cartilage characteristics, and aesthetic goals.
Why We Don't Decide Based on the Technique's Name
Some patients believe the technique should be chosen before the consultation, when in reality the decision begins with anatomical assessment, followed by selecting the most suitable surgical approach. This is why Dr. Mohamed El Assal does not choose the technique first — he chooses the solution that best serves the patient's case.
In other words, the goal is not to convince the patient of a particular technique because it is "modern" or "trending", but to determine what genuinely suits their individual anatomy after careful examination. This is precisely what ensures a safe, harmonious result, regardless of the name of the technique used.
In other words, the goal is not to convince the patient of a particular technique because it is "modern" or "trending", but to determine what genuinely suits their individual anatomy after careful examination. This is precisely what ensures a safe, harmonious result, regardless of the name of the technique used.
Frequently Asked Questions
Are there visible scars?
Open preservation rhinoplasty involves a small columellar incision, while the closed approach leaves no external scars. Internal scarring is reduced because tissues are preserved as a unit.
Are results permanent?
Yes, results are generally permanent. Like any nose, very subtle natural changes occur with aging over decades.
Can it be applied to thick skin?
Its principles can be applied, but thick skin conceals fine details and may require additional tip-defining techniques. Realistic expectations are discussed thoroughly during consultation.
Is Preservation better than the traditional method?
It is neither universally better nor worse; each technique is a surgical tool used in the appropriate case after comprehensive clinical assessment.
Is it suitable for all patients?
No, it suits cases whose anatomical structure safely allows preservation, determined through direct examination, not patient preference.
Can it be used in revision surgeries?
Only in limited cases; most complex revision surgeries require a structural approach due to structural changes from the previous surgery.
Does it preserve breathing function?
It aims to preserve or improve breathing function as needed, particularly for patients already experiencing partial obstruction.
Does it reduce swelling?
It may be associated with less swelling or a smoother recovery in some selected cases, though this varies depending on anatomy, healing nature, and the technique used.
Can it be combined with septoplasty?
Yes, septal deviation correction can be combined within the same surgical session when needed.
Does it mean the hump is not removed?
No, the hump is lowered using a method that preserves its natural connection to the surrounding framework, rather than being left untouched.
Does it mean no cartilage is used?
It generally requires less additional cartilage than structural techniques, but this does not mean cartilage is never used in any case.
How do I know if it's suitable for me?
Only through direct clinical examination assessing hump shape, bridge height, nasal roof integrity, and skin thickness.
Are scars less with this technique?
With the closed approach there is no visible scarring; even with a limited open approach the scar remains very small and fades over time.
Are the results permanent?
Yes, the results are structurally permanent, with natural age-related changes continuing over time — minor changes related to natural ageing rather than the technique itself.
Can it be applied to thick skin?
It can be applied in selected cases after careful assessment. Patients with thick skin are not automatically excluded — the decision is made after comprehensive evaluation, though it is not always the optimal choice for these cases.
Who trained Dr. Mohamed El Assal in this technique?
Dr. Mohamed El Assal trained directly with Prof. Yves Saban, one of the foremost pioneers of Preservation Rhinoplasty worldwide.
Also read
"In preservation surgery, the goal is never to preserve natural structure at any cost — it is to preserve it when doing so achieves the best balance between form and function."
— Dr. Mohamed El Assal
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Scientific References
✔ European Academy of Facial Plastic Surgery (EAFPS) ✔ Preservation Rhinoplasty — Yves Saban ✔ Daniel RK — Rhinoplasty ✔ Rohrich RJ ✔ Toriumi DM — Structural Rhinoplasty ✔ International Society of Aesthetic Plastic Surgery (ISAPS)
Disclaimer
The information on this page is intended for general educational purposes and does not replace direct medical consultation. Results and expectations vary between patients based on individual clinical assessment.