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. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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Background Hump recurrence is one of the commonly encountered problems following dorsal preservation rhinoplasty (DP) during the learning period. Objective The aim of this paper is to discuss different methods for the prevention and treatment of dorsal problems following dorsal preservation surgery. Methods One hundred fifty primary rhinoplasty patients were included in our study. The noses were classified as to both hump shape (V- or S-shaped) and height. All patients had a dorsal preservation rhinoplasty with either a push-down (PD) or a let-down (LD) technique. The PD method was used for humps <4 mm and the LD for humps >4mm. Follow up evaluations were made with physical examination and photographs at 1 week, 3 months, and 12 months. Results Mean follow-up was 12.68 ± 1.78 months. 78 humps were V-shaped and 72 were S-shaped. PD was used for 77 cases, LD for 83 cases. 8 patients (5.3%, 8/150) had a visible dorsal hump problem after DP surgery. Based on their preoperative hump shape, 3 cases were V-shaped and 5 were S-shaped. All recurrent cases had a preoperative hump deformity greater than 4 mm. The revision procedures were as follows: 4 patients had PD procedure, 3 had a LD procedure, and one patient was treated by classic open resection rhinoplasty. Conclusion We can say that there is a relatively correlation between preoperative hump height and eventual hump recurrence. The complication rate can be decreased with additional technical maneuvers and proper patient selection.

Although there was no significant difference between the groups, rats receiving autologous fat graft showed better regeneration. Combined use of autologous fat graft with surgical repair methods induced significantly better regeneration. It was concluded that autologous fat grafting may have a beneficial effect on nerve regeneration when it is present in the coaptation site during healing.

Reverse superior labial artery pedicled nasolabial island flap proved to be a good choice for reconstruction of the lower nose and moderate sized medial cheek defects. This pedicle should be considered where the defect is located on the course of lateral nasal artery or angular artery. Arc of rotation and reliability of this new flap is considered superior to angular artery and infraorbital artery-based nasolabial flaps where these arteries could also be used as pedicle.