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

Plast Reconstr Surg. 2019 Sep;144(3):378e-385e. doi: 10.1097/PRS.0000000000005909.


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 2016 and 2018 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.

Clinical question/level of evidence: Therapeutic, IV.

MeSH terms

  • Esthetics
  • Female
  • Follow-Up Studies
  • Humans
  • Ligaments / anatomy & histology
  • Ligaments / surgery*
  • Male
  • Microsurgery / adverse effects
  • Microsurgery / methods*
  • Nose / anatomy & histology*
  • Nose / diagnostic imaging
  • Nose / surgery
  • Photography
  • Recurrence
  • Reoperation / statistics & numerical data
  • Rhinoplasty / adverse effects
  • Rhinoplasty / methods*
  • Secondary Prevention / methods*
  • Treatment Outcome