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

Tuncel, Umut M.D.; Aydogdu, Oguzhan M.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 378e-385e
doi: 10.1097/PRS.0000000000005909
Cosmetic: Original Articles

Background: Nasal hump relapse and its probable reasons or mechanisms have been less discussed after dorsal preservation rhinoplasty. In this article, the authors would like to share their experiences and offer solutions regarding this subject.

Methods: Five hundred twenty patients who underwent primary rhinoplasty between the years 2015 and 2017 were included in the study. The push-down method was used for noses with a hump less than 4 mm 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 their probable mechanisms.

Results: Five hundred twenty patients, 448 with a straight nose and 72 with a deviated nose, were enrolled in this study. Mean follow-up was 13 months (range, 9 to 16 months). Visible dorsal hump recurrence was observed in 63 patients, and they appeared at 1 to 4 months postoperatively. Forty-one of these had a dorsal hump more than 4 mm preoperatively. Hump recurrence was not more than 2 mm in 34 patients, and they did not wish to have any revision intervention because of cosmetic satisfaction. In 11 cases, the height of the hump recurrence was 2 to 3 mm. These patients were treated with only minimal rasping. The remaining 18 patients had a hump recurrence with a height of 3 to 4 mm. They underwent secondary surgery using let-down rhinoplasty.

Conclusion: The authors recommend subperichondrial/subperiosteal dissection, subdorsal excision of cartilaginous and bony septum, scoring the resting upper part of the septum just below the keystone area, and performing lateral keystone dissection and preferring let-down procedure for kyphotic noses to prevent hump relapse after dorsal preservation rhinoplasty.


Samsun, Turkey

From the Departments of Plastic Reconstructive and Aesthetic Surgery of Liv Hospital and Medicana İnternational Hospital.

Received for publication October 23, 2018; accepted February 28, 2019.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Umut Tuncel, M.D., Department of Plastic Reconstructive and Aesthetic Surgery, Liv Hospital, F Sultan Mehmet Street, 55100 Samsun, Turkey,, Instagram: @drumuttuncel

Copyright © 2019 by the American Society of Plastic Surgeons