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The probable reasons of dorsal hump problems following let-down / push-down rhinoplasty and solution proposals

Tuncel, Umut MD; Aydogdu, Oguzhan MD

Plastic and Reconstructive Surgery: June 5, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005909
Original Article: PDF Only

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.

Umut TUNCEL MD, Assistant Professor; Department of Plastic Reconstructive and Aesthetic Surgery, Liv Hospital 55100, Samsun, TURKEY. E-mail;, Phone; +90 532 724 93 84

Oguzhan AYDOGDU MD, Department of Plastic Reconstructive and Aesthetic Surgery, Medicana İnternational Hospital, 55100, Samsun, TURKEY. E-mail;, Phone; +90 505 377 70 28

Each author disclose at the time of submission any commercial associations or financial disclosures that might pose or create a conflict of interest with information presented in any submitted manuscript. Such associations include consultancies, stock ownership, or other equity interests, patent licensing arrangements, and payments for conducting or publicizing a study described in the manuscript. Authors disclose any funding received for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s). This information will be printed with the article.

Acknowledgement: “None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Corresponding author: Umut Tuncel, MD, Department of Plastic Reconstructive and Aesthetic Surgery, Liv Hospital, Samsun, 55050/Turkey. E-mail:, Phone: +90 532 724 93 84, Fax: +90 362 999 80 00

©2019American Society of Plastic Surgeons