Reducing Dorsal Hump Recurrence Following Push Down-Let Down Rhinoplasty

Overview

Hump recurrence is a common problem for surgeons learning dorsal preservation, in which the bridge is lowered rather than cut away. This study compared methods for preventing and treating that recurrence. One hundred and fifty primary rhinoplasty patients were classified by hump shape and hump height, then treated by push down or let down. Follow up was by physical examination and photographs at 1 week, 3 months and 12 months.

Sections of note

• 150 primary rhinoplasty patients; mean follow up 12.68 months, standard deviation 1.78.
• Humps were classified as V shaped, 78 cases, or S shaped, 72 cases.
• The push down technique was used for humps under 4 mm, in 67 cases; the let down technique for humps over 4 mm, in 83 cases.
• Eight patients, 5.3 percent, had a visible dorsal hump problem after surgery.
• Of those 8, three had been V shaped and five S shaped preoperatively.
• All recurrent cases had a preoperative hump greater than 4 mm.
• Revisions were 4 push down, 3 let down and 1 classic open resection rhinoplasty.

What it means for a patient

• A taller starting hump is associated with a higher chance the bump comes back after preservation surgery.
• About one in nineteen patients in this series needed a second operation on the bridge within roughly a year.
• Follow up averaged about 12 months, so later recurrences would not be captured.
• This is a single centre series without a randomized comparison between push down and let down.

Why this paper matters

Preservation rhinoplasty is judged on whether the lowered bridge stays down, and this paper puts a number on how often it does not. It ties recurrence directly to preoperative hump height, which is measurable before surgery. It does not establish which added maneuvers actually prevent recurrence.

Terms

• Dorsal hump: the bump on the bridge of the nose.
• Dorsal preservation: lowering the natural bridge instead of removing the hump.
• Push down: releasing the nasal framework so it sinks into the face.
• Let down: removing a wedge of bone at the sides so a taller framework can settle further.
• Recurrence: the hump becoming visible again after surgery.