The Probable Reasons for Dorsal Hump Problems following Let-Down/Push-Down Rhinoplasty and Solution Proposals

• Published in: Plastic and reconstructive surgery (1963) Vol. 144; no. 3; pp. 378e - 385e
• Main Authors: Tuncel, Umut, Aydogdu, Oguzhan
• Format: Journal Article
• Language: English
• Published: United States by the American Society of Plastic Surgeons 01-09-2019; American Society of Plastic Surgeons
• ISSN: 0032-1052; 1529-4242
• DOI: 10.1097/PRS.0000000000005909

BACKGROUND:Hump relapse and its probable reasons or mechanisms have been less discussed after dorsal preservation rhinoplasty. In this paper, the authors would like to share their experiences and solution offers about this subject.
METHODS:520 patients who underwent primary rhinoplasty between 2015-2017 years were included to the study. The push-down method was used for the noses with hump less than 4mm and the let-down procedure was performed for others. Hump height was measured from profile photographs. The cases were evaluated in terms of nasal dorsal problems and its probable mechanisms.
RESULTS:520 patients, 448 with a straight and 72 with a deviated nose were enrolled in this study. Mean follow-up was 13 months (range, 9-16 mo). Visible dorsal hump recurrence was observed in 63 patients, and they appeared at 1-4 months postoperatively. 41 of these had dorsal hump more than 4mm preoperatively. Hump recurrence was not more than 2 mm in 34 patients, and they didn’t wish to have any revision intervention due to cosmetic satisfaction. In 11 cases, the height of the hump recurrence was 2-3 mm. These patients were treated with only minimal rasping. The remaining 18 patients had a hump recurrence with a height of 3-4 mm. They underwent secondary surgery with using let-down rhinoplasty.
CONCLUSIONS:We recommend subperichondrial/subperiosteal dissection, subdorsal excision of cartilaginous and bony septum, scorring resting upper part of septum just below K-area, and performing lateral keystone dissection and preferring let-down procedure for kyphohtic noses for prevent hump relapse after dorsal preservation rhinoplasty.