Dorsal Preservation Rhinoplasty · NOVA Spare Roof

Preservation rhinoplasty in Madrid: the NOVA Spare Roof technique

Medically reviewed by Dr. Iván Méndez-Benegassi Silva · Otorhinolaryngology (ENT) Specialist with over 25 years of experience in sleep surgery and advanced rhinology · European Board Certificate (ORL-HNS) · HM Hospitales, Madrid · License No. 282855946

Last reviewed: Sep 26, 2026

Training in this technique

The NOVA Spare Roof technique and the Sail Maneuver were published in 2025 [1]. Dr. Méndez-Benegassi trained in them with the surgeons who developed them.

The Core Principle

Preserving vs. Cutting: Why Keep Your Natural Bridge?

Think of your nasal bridge like the original roof of a house. In traditional rhinoplasty, the surgeon cuts away the hump from above, breaking the natural arch and leaving an open hole (“open roof”) that must be rebuilt with cartilage grafts. In preservation rhinoplasty, your natural roof is kept completely intact: we gently lower it from its foundation, eliminating the bump while preserving your natural smooth contours.

Your own bridgeLowered instead of cut away

Valve support keptThe internal nasal valve keeps its framework

No classic packingSmall external splint for about 7 days

Surgical Sequence

How Does NOVA Spare Roof Work? Step-by-Step Descent

3D vectorial model of NOVA Spare Roof preservation rhinoplasty: paramedian osteotomy, keystone release and descent vectors — **Anatomical Model: NOVA Spare Roof & The Sail Maneuver**The diagram shows the 5 mechanical stages: prior diamond burring of the hump, excision of an underlying osteocartilaginous lamina, wedge cut of the upper lateral cartilage (in blue), downward push-down pressure, and overlapped suturing of the cartilage sail without external skin punctures.Diagram by Dr. Méndez-Benegassi, adapted from Ferreira et al., 2025 [1].

Prior Diamond Burring of the Hump

Before lowering the bridge, a fine diamond burr or piezotome gently planes the surface of the bone and cartilage. This eliminates natural micro-irregularities (such as S-shaped bony ridges) so the roof settles into the exact planned profile.

Excision of Underlying Osteocartilaginous Lamina

A calibrated strip of bone and cartilage is excised from underneath the bridge (the septal strip). This creates the necessary free space for descent while leaving the superficial roof untouched.

Calibrated Wedge Cut of the Upper Lateral Cartilage

A calibrated triangular wedge is removed and the upper lateral cartilage is released, liberating tension and preparing the cartilage flap (“the sail”).

Controlled Downward Pressure (Push-Down)

Gentle downward pressure is applied to the pre-burred dorsum. It settles smoothly into the freed bed, achieving the desired profile without step-offs.

Overlapped Cartilage Suture (Sail Maneuver)

The upper lateral cartilage is sutured in an overlapped (acabalgado / overlay) position using internal sutures. This provides permanent solid fixation and reinforces the internal nasal valve without requiring external skin needle punctures.

Direct Comparison

Traditional Rhinoplasty vs. NOVA Preservation Rhinoplasty

Concept	Traditional Reduction	NOVA Preservation
Dorsal Roof	Resected (open roof that must be rebuilt)	Preserved and lowered (no open roof)
Lateral Keystone Area	Disarticulated and severed	Preserved intact (Sail Maneuver)
Internal Nasal Valve	Requires reconstruction with spreader grafts	Its support is kept (overlapped cartilage)
Dorsal irregularities	More frequent	Less frequent in studies [4]
Residual or recurrent hump	Less frequent	More frequent in studies; about 4% [4][5]

Ideal Candidate

Primary surgery (first time, no prior rhinoplasty).
Moderate to prominent dorsal hump.
Desire for a natural, smooth bridge without an "operated" look.
Protection of nasal breathing and internal valve support.

When Another Technique is Better

Severe S-shaped crooked noses with marked bridge asymmetry.
Complex revision rhinoplasty where dorsal cartilage was already resected.
Saddle nose deformities requiring structural cartilage grafting.
In these cases, structural or ultrasonic rhinoplasty.

Clinical Self-Assessment

Nasal Evaluator: Functional vs Cosmetic Rhinoplasty

Patient Decision Aid

Discover whether your nasal obstruction requires endonasal septal correction, dynamic nasal valve reinforcement, or a combined preservation rhinoplasty approach.

1. Dynamic Nasal Valve & Alar Wall

2. Pattern of Internal Obstruction

3. External Appearance & Anatomy Concerns

Tick what applies to you. Your guidance appears as soon as you answer question 2.

Comfort & Healing

Gentle Postoperative Experience: No Painful Packing

Internal absorbable sutures hold the cartilage, so Dr. Méndez-Benegassi does not use classic nasal packing: you breathe through your nose from day one and avoid the discomfort of packing removal. Some swelling and bruising are normal in the first days.

Day 1 to 7Small external splint. Mild discomfort, controlled with simple painkillers.

Day 7Splint removal in clinic. Return to social and work life.

Months 1 to 12About two-thirds of the swelling is gone by month 1. Refined final result at 1 year.

Results and risks: what the studies say

A 2025 meta-analysis of 10 studies and 1,339 patients compared preservation with classic hump reduction: preservation had fewer dorsal irregularities (relative risk 0.28) but more residual or recurrent hump (relative risk 2.94), with no differences in breathing or in the need for revision surgery [4].

Another meta-analysis of 22 studies and 5,660 patients reported hump recurrence in 4.18% of cases, revision surgery in 3.48%, nasal deviation in 1.13% and infection in 1.89% [5].

If your main problem is breathing, read about functional septorhinoplasty. Not sure which operation fits your case? See which nose operation you need and whether an ENT or a plastic surgeon should operate.

Key Questions Answered

Frequently Asked Questions

What is preservation rhinoplasty and how does it differ from traditional rhinoplasty?

In traditional rhinoplasty, the nasal hump is cut away (resected), opening the nasal roof and requiring spreader grafts to reconstruct it. In preservation rhinoplasty, your own bridge of bone and cartilage is kept and lowered from below, which aims for a smooth bridge without palpable steps or sharp edges.

What is the NOVA Spare Roof technique and why is the hump burred beforehand?

NOVA Spare Roof is a modern technique where the dorsal hump is treated as a geometric triangle. Before lowering it, the bridge is finely smoothed with a diamond burr or piezosurgery to eliminate native irregularities and adapt the profile. Then, it descends smoothly into the freed bed, perfecting the Dorsal Aesthetic Lines.

What is the Sail Maneuver and why does it avoid cutting the lateral keystone?

Traditional push-down techniques required disarticulating the lateral keystone area (the junction between nasal bone and upper lateral cartilage) and severing the pyriform ligament. The Sail Maneuver creates calibrated mirror osteotomies, allowing the dorsum to descend while keeping the lateral keystone and pyriform ligament completely intact for maximum structural stability.

How do NOVA Spare Roof and the earlier Spare Roof B differ, and why do we prefer NOVA?

In Spare Roof B, securing the cartilage required external transcutaneous needle sutures through the skin ("hump-apex suture") and disarticulating the lateral keystone. In NOVA Spare Roof (2025), after excising an underlying osteocartilaginous strip and sectioning a calibrated cartilage wedge, the pre-burred dorsum is pressed down and the cartilage is sutured in an overlapped (acabalgado / overlay) position with internal sutures. We prefer NOVA because it avoids skin punctures, leaves the lateral keystone intact and, according to its authors, helps support the internal nasal valve.

Can the hump come back after preservation rhinoplasty?

It can. A 2025 meta-analysis of 10 studies (1,339 patients) found that preservation leaves fewer dorsal irregularities than classic hump reduction, but more residual or recurrent hump; breathing results and the need for revision surgery were similar. Another meta-analysis of 22 studies (5,660 patients) put hump recurrence at 4.18% and revision surgery at 3.48%. That is why the technique is chosen case by case.

Who is an ideal candidate for preservation rhinoplasty and when is it not recommended?

It is ideal for primary patients (no previous rhinoplasty) with a moderate or prominent hump who want to eliminate the bump while preserving their natural bridge and breathing. It is not recommended for severely crooked S-shaped noses, complex revision cases with destroyed dorsal cartilage, or saddle nose deformities that require structural cartilage grafting.

Will I have painful nasal packing and how is the recovery?

In the vast majority of cases, no: Dr. Méndez-Benegassi avoids classic packing and uses internal micro-sutures or biodegradable splints, allowing you to breathe from day one without painful packing removal. A light external splint is worn for 7 days, after which most patients resume social and work activities.

Where you are seen in Madrid

Consultations and clinical assessments are held at HM Madrid, HM Tres Cantos, and HM Valdebebas, in a hospital setting, with an optical microscope and piezoelectric instruments.

Certified Credentials & Memberships

Accredited Memberships & Scientific Societies

Dr. Méndez-Benegassi brings together the three essential pillars for advanced rhinoplasty: functional airway surgery, European facial plastic surgery, and facial aesthetic medicine.

SEORL-CCC

Spanish Society of Otorhinolaryngology and Head & Neck Surgery

ENT Specialist · Airway, Valve & Functional Septum

Official ENT Society in Spain→

EAFPS

European Academy of Facial Plastic Surgery

Active Member · European Facial Plastic & Reconstructive Surgery

European Benchmark in Rhinoplasty & Facial Plastic Surgery→

SEME

Spanish Society of Aesthetic Medicine

Full Member · Master's with Honors in Facial Aesthetics (UCM)

Facial Proportions, Aesthetics & Facial Balance→

Personalized Clinical Care

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References

Ferreira MG, Lyrio TM, Tamanqueira P, Ardila Bernal ADP, Dourado N, Santos M. NOVA Spare Roof Technique and the Sail Maneuver—Vectorial Rhinoplasty Without Lateral Keystone Area Disarticulation. Facial Plast Surg Aesthet Med, 2025;27(6):536-541. PMID 40277124. doi.org/10.1089/fpsam.2024.0349
Ferreira MG, Santos M, Oliveira e Carmo D, Fertuzinhos A, Almeida e Sousa C, Santos J, Dourado N, Amarante J. Spare Roof Technique Versus Component Dorsal Hump Reduction: A Randomized Prospective Study in 250 Primary Rhinoplasties, Aesthetic and Functional Outcomes. Aesthet Surg J, 2021;41(3):288-300. PMID 32722776. doi.org/10.1093/asj/sjaa221
Gonçalves Ferreira M, Ishida LC, Ishida LH, Santos M. Ferreira-Ishida Technique: Spare Roof Technique B. Step-by-Step Guide to Preserving the Bony Cap While Dehumping. Plast Reconstr Surg, 2022;149(5):901e-904e. PMID 35472049. doi.org/10.1097/PRS.0000000000009060
Ribeiro LFS, De Freitas LR, Udoma-Udofa OC, et al. Dorsal preservation versus dorsal reduction rhinoplasty techniques for aesthetic and functional outcomes: a systematic review and meta-analysis. J Plast Reconstr Aesthet Surg, 2025;107:101-118. PMID 40580891. doi.org/10.1016/j.bjps.2025.05.044
Tham T, Bhuiya S, Wong A, Zhu D, Romo T, Georgolios A. Clinical Outcomes in Dorsal Preservation Rhinoplasty: A Meta-Analysis. Facial Plast Surg Aesthet Med, 2022;24(3):187-194. PMID 35172105. doi.org/10.1089/fpsam.2021.0312
Stewart y cols., validación de la escala NOSE para valoración de obstrucción nasal. Otolaryngol Head Neck Surg, 2004. PMID 14990910. doi.org/10.1016/j.otohns.2003.09.016
Pavri S, Zhu VZ, Steinbacher DM. Postoperative Edema Resolution following Rhinoplasty: A Three-Dimensional Morphometric Assessment. Plast Reconstr Surg, 2016;138(6):973e-979e. PMID 27879585. doi.org/10.1097/PRS.0000000000002760