Northern mediterranean nose correction: Italian experience: Preservation approach

The history of the Mediterranean area sees the migration of many people from various parts of the world with the consequent development of what we now call the Caucasians. According to our experience, the vast anatomical variability of this ethnic group is such that it does not allow the surgeon to apply one and only one philosophy in the aesthetic/functional approach to the nose. It is essential that the rhino-surgeon has numerous techniques in his arsenal, in order to apply the one that is most suitable for the clinical case. The Preservation approach, contrary to what one might think, turns out to be very heterogeneous and varied, allowing the treatment of different types of nose and at the same time guaranteeing natural results with rapid postoperative recovery. This philosophy has three cardinal principles: the soft tissues, the dorsal, and the alar cartilages preservation. From our point of view, there is another fundamental structure that must not be put aside, the nasal septum. To correct a nasal deformity, it is mandatory to understand the causes and processes that led that structure to acquire a given shape with the aim of choosing a technique able to reverse that evolutionary process. The result is a philosophy which, depending on the case, can be purely preservative or balancing preservation (manipulation, remodeling, etc.) with resection/restructuring/structuring. The ultimate goal is to create a correct structure where all is placed in the right anatomical position, occupying the right space without leaving dead spaces. Preservation of the ligaments reduces the postoperative fibrosis which is often able to modify a well-constructed framework. In the Mediterranean population, anatomical variability is really important not only as osteo-cartilaginous structures but also as soft tissues. The aim of this chapter is to focus on the dorsal-septal unit and describe the extreme anatomical variability showing the key points that need to be analyzed when choosing the best technique.