Combination of the Push-Down and Let-Down Techniques: Mix-Down Approaches.

[BACKGROUND] Rhinoplasty is one of the most widely conducted and challenging types of aesthetic surgical operations, and dorsal hump reduction is a commonly performed aesthetic surgery among Caucasian patients. Dorsal hump resection is traditionally conducted by removing the dorsal nasal bone and cartilage. The push-down and let-down techniques are used for dorsal preservation in dorsal hump reduction operations. Different patients require different approaches to achieve the best results in terms of aesthetic appearance and functionality.

[OBJECTIVES] In the present research, the author describes two novel approaches that combine the push-down and let-down techniques for appropriate patients.

[METHODS] The records of 45 patients (40 females and 5 males) were assessed, and those who were eligible for the present approaches were included. The author defined two approaches in which the push-down and let-down techniques were used simultaneously (mix-down methods). All patients included in the study completed the Rhinoplasty Outcome Evaluation (ROE) questionnaire before surgery and at their one-year follow-up appointment.

[RESULTS] The median ROE scores were 60.1 points before surgery and 92.2 points one year after surgery; this difference was statistically significant (p<0.001).

[CONCLUSIONS] The present study is the first to demonstrate the beneficial effects of combining the push-down and let-down techniques in a selected patient population. These new approaches will improve both cosmetic and functional outcomes and allow surgeons to choose the best option for patients who are eligible for these mix-down approaches.

[LEVEL OF EVIDENCE IV] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .