Facial plastic surgery · London
Preservation rhinoplasty, by a named London specialist.
A modern rhinoplasty that keeps your natural dorsum and alar cartilages, rather than resecting and rebuilding them. In the right nose, that means softer results, no open-roof to close, and a lower revision rate.
Why patients choose us
- 01
A named preservation rhinoplasty surgeon, not a generalist
A BAAPS or BAPRAS-registered facial plastic or ENT surgeon with a high volume of dorsal-preservation and cartilage-sparing cases, not an occasional rhinoplasty on a mixed list.
- 02
The right technique for your nose
Preservation is elegant when it fits. For deviated bony vaults, revision cases or thick S-shaped humps, we say so, and offer classical structural rhinoplasty or piezo instead.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What preservation rhinoplasty costs in London.
Indicative ranges across our vetted London panel. Send us your photos and we quote firm figures across two or three named surgeons.
In short
Primary preservation rhinoplasty in our London network: £6,500-£16,500, day case or one night.
| Procedure | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Consultation, photos and 3D simulation | £250-£450 | 45-60 min | Same visit |
| Preservation rhinoplasty (dorsal preservation only) | £6,500-£12,500 | 2-2.5 hrs | Day case |
| Preservation rhinoplasty with tip refinement | £9,500-£16,500 | 2.5-3.5 hrs | Day case |
| Revision preservation rhinoplasty | £12,500-£22,000 | 3-4.5 hrs | 1 night |
| Ultrasonic piezo add-on for bony work | £800-£1,600 | +30-45 min | Same visit |
| Second-opinion review of prior surgical plan | £250-£450 | 30 min | 48 hours |
Prices vary by surgeon, by hospital, by whether piezo osteotomies and 3D imaging are used, and by the complexity of the tip and septum work. We come back with a firm quote within one working day.
The journey
From first photos to the 1-year review.
One team from the first enquiry through consultation, surgery and every review. We stay with you to 12 months.
- 01
Before
You send us photos and a short brief
A confidential form with front, side and three-quarter photos, what you like and dislike about your nose, and any prior surgery or trauma.
- 02
Before
We come back with a recommendation
Within one working day: whether preservation fits, or whether classical structural rhinoplasty is the safer call. Two or three named surgeons, indicative prices.
- 03
Before
Consultation and imaging
Face-to-face consultation, 3D morphing simulation where offered, and a CT scan if the bony vault or septum need mapping.
- 04
On the day
Admission and anaesthetic
Day-case or one-night stay. General anaesthetic, prophylactic antibiotics, and a hypotensive technique to keep the field clean.
- 05
On the day
The preservation rhinoplasty itself
2 to 3 hours. Subdorsal Cottle, high strip or low strip dorsal preservation with pushdown or letdown of the bony vault, and cartilage-sparing tip work.
- 06
On the day
Home the same day or next morning
A light external splint, no nasal packing in most cases, and written aftercare. Someone must collect you and stay the first night.
- 07
After
Splint off, review at 1 year
Splint removed at 7 days. Swelling settles over 3 to 6 months, with the final result at 12 months. Review at 1 week, 6 weeks, 6 months and 1 year.
When it fits
When preservation is the right technique, and when it is not.
Preservation is elegant when the anatomy suits it. It is not a universal answer. Here is when we recommend it, and when we send you back to classical structural rhinoplasty.
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Mild to moderate dorsal hump
A convex bony-cartilaginous hump on a straight, symmetric nose is the classical preservation indication.
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Small dorsal irregularities
A subtle bump or supratip fullness where lowering the whole dorsum in one piece keeps the natural line intact.
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The unique family or ethnic profile
Where you want to soften the hump but keep the character of the nose, preservation retains the native dorsal aesthetic lines.
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Avoiding open-roof deformity
Dorsal preservation leaves the keystone area intact, so there is no open roof to close and no middle-vault collapse to prevent.
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Avoiding spreader grafts
The upper lateral cartilages stay attached to the septum, so most preservation cases do not need spreader grafts to protect the internal valve.
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Shorter recovery in selected cases
Less soft-tissue dissection over the dorsum can mean quicker resolution of oedema in the first six weeks, though the 12-month endpoint is the same.
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Severe deformity or crooked bony vault
Marked deviation, wide bony base or complex asymmetry are better served by classical structural rhinoplasty with osteotomies and grafts.
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Previous rhinoplasty or thick skin
A revision nose with scarred tissue planes, or very thick sebaceous skin, usually falls outside the preservation indication.
Technique options
Preservation is a family of techniques - and classical rhinoplasty sits beside it.
What each option involves, and where each fits. For a crooked bony vault or a revision case, classical structural rhinoplasty is usually the safer call.
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Subdorsal Cottle
The dorsal septum is preserved and a subdorsal strip is excised at the level of the perpendicular plate. Suits low humps with a straight dorsum.
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High septal strip
A strip of septal cartilage is removed high, just below the dorsum, then the dorsum is pushed or let down. A workhorse variant with wide indications.
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Low septal strip
The strip is taken lower on the septum, useful when the caudal septum needs shortening as well as dorsal lowering.
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Pushdown vs letdown
Pushdown impacts the bony vault into the pyriform aperture; letdown removes a lateral bony wedge before dropping the vault. Letdown suits larger humps.
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Cartilage preservation tip
Kovacevic and Saban tip-preservation techniques reshape the alar cartilages with sutures and minimal excision, preserving structural support.
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Ultrasonic piezo osteotomies
Piezoelectric handpieces cut and rasp bone precisely without traumatising surrounding soft tissue, reducing bruising and sharpening bony contour.
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Classical structural rhinoplasty
Hump reduction, osteotomies and spreader grafts. Proven, durable and versatile, with a 10 to 15% revision rate in the literature.
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Second-opinion review
A specialist review of a prior surgical plan, morphs and photos. Sometimes the honest answer is a different technique or a different surgeon.
Our vetted London panel
A small panel of preservation rhinoplasty specialists, we picked them.
Recognised centres include Cadogan Clinic, London Bridge Cosmetic Surgery, HCA The Wellington, King Edward VII’s and London Facial Plastic Surgery. Named specialists such as Prof Andrew Foreman (piezo) and Mr Alwyn D’Souza (preservation). Introductions are private.
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BAAPS or BAPRAS-registered facial plastic or ENT rhinoplasty specialists
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Documented high volume of dorsal-preservation and cartilage-preservation cases
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Access to piezoelectric instrumentation and CT-based planning where indicated
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Clear revision policy and honest counselling on when preservation is not the answer
Safety and recovery
What to expect afterwards - honestly.
Preservation rhinoplasty is well established but not risk-free. The things worth planning are bruising, the splint, the taping schedule, and the 12-month endpoint for judging the result.
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General anaesthetic in a CQC-registered hospital
Consultant anaesthetist, hypotensive technique to keep the surgical field clean, and prophylactic antibiotics on induction.
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Bruising and swelling
Periorbital bruising for 10 to 14 days. Most patients return to desk work at 2 weeks and to the gym at 4 to 6 weeks.
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Dorsal recurrence, hump return
A recognised issue in dorsal preservation, quoted at 3 to 8% in specialist series. Careful technique and case selection matter more than any single manoeuvre.
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Nasal obstruction
Uncommon after preservation because the internal valve is left intact, but septoplasty or turbinate reduction may still be needed for pre-existing obstruction.
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Infection and bleeding
Under 1% in modern series. Antibiotic cover, no nasal packing in most cases, and a 24-hour contact number for the first fortnight.
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Splint and taping
A thermoplastic or plaster splint for 7 days, then night-time taping for a further 2 to 4 weeks to control supratip swelling.
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The 12-month result
The nose looks 80% settled at 3 months, 90% at 6 months. Judge the final result at 12 months, when residual supratip oedema is gone.
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Revision rate
Preservation rhinoplasty in expert hands: 3 to 8%. Classical structural rhinoplasty in the literature: 10 to 15%. Case selection is the biggest single lever.
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Red flags after discharge
Fever, severe unilateral pain, expanding bruising, sudden loss of vision or a change in nasal skin colour: call the surgical team or attend A&E the same day.
Frequently asked
Everything we get asked about preservation rhinoplasty.
Quick answers on candidacy, cost, recovery and how it compares to classical rhinoplasty.
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What is preservation rhinoplasty and how is it different?
Preservation rhinoplasty is a modern approach that keeps the natural dorsum and alar cartilages intact rather than resecting a hump and rebuilding the framework. In a classical Joseph-style rhinoplasty, the hump is cut off and osteotomies close the resulting open roof. In preservation, the whole dorsum is dropped en bloc by removing bone and cartilage from below, so the native dorsal lines are conserved.
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Am I a candidate for preservation rhinoplasty?
The best candidates have a mild to moderate dorsal hump on a straight, symmetric nose with reasonable skin thickness, and want to keep the natural character of their profile. Preservation is generally not the right choice for severe deformities, markedly deviated bony vaults, revision cases or very thick sebaceous skin, where classical structural rhinoplasty tends to give more predictable results.
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How much does preservation rhinoplasty cost in London?
Indicative ranges in our network are £6,500 to £12,500 for dorsal preservation alone, £9,500 to £16,500 with tip refinement, and £12,500 to £22,000 for revision preservation cases. An ultrasonic piezo add-on for the bony work is £800 to £1,600. We confirm a firm figure within one working day.
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What is the recovery like?
You go home the same day or the next morning with a light splint. Bruising and swelling around the eyes settle over 10 to 14 days. The splint comes off at 7 days. Most people return to desk work at 2 weeks and to the gym at 4 to 6 weeks. The nose looks broadly settled at 3 months, with the final refinement visible at around 12 months.
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Is preservation rhinoplasty safer than classical rhinoplasty?
Neither is inherently safer. Preservation avoids some classical pitfalls such as open-roof deformity and middle-vault collapse, and often needs no spreader grafts. Classical structural rhinoplasty has a longer track record and handles a wider range of noses. The published revision rate for classical rhinoplasty is 10 to 15%, while specialist preservation series report 3 to 8%. Case selection matters more than the label.
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Where is preservation rhinoplasty done in London?
Recognised London centres for preservation and piezo rhinoplasty include Cadogan Clinic, London Bridge Cosmetic Surgery, HCA The Wellington, King Edward VII’s and London Facial Plastic Surgery, with BAAPS and BAPRAS-registered specialists such as Prof Andrew Foreman (piezo) and Mr Alwyn D’Souza (preservation). We introduce you to two or three named surgeons whose case mix fits your nose.
Ready when you are
Send us your photos. We come back with two or three named surgeons within a working day.
An honest read on whether preservation fits your nose, indicative prices from our London panel, and a private introduction to the surgeon whose case mix matches best.
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