Preventing Cheesewire and Hump Recurrence in Low Strip Preservation Rhinoplasty

Hump recurrence represents a potential complication of preservation rhinoplasty. In the low septal strip technique, the quadrangular cartilage functions as a rotational advancement flap anchored to the anterior nasal spine. Proper fixation is crucial to prevent hump recurrence caused by backward rotation of the flap.

All primary preservation rhinoplasties performed by the same surgeon with the low septal strip septoplasty technique between January of 2021 and December of 2023 were analyzed retrospectively, comparing conventional fixation with mattress sutures to a novel technique, referred to as kite fixation. The primary outcome variables were the presence or absence of hump recurrence and the need for revision surgery.

A total of 823 patients were included in the study, with 405 in the conventional fixation group and 418 in the kite-shaped fixation group. Demographic characteristics were comparable between the groups. Statistically significant differences were observed in terms of hump recurrence (4.6% versus 1.2%) and the necessity of revision surgery (4.3% versus 1.1%).

Hump recurrence and minihumps remain significant drawbacks in preservation rhinoplasty. Proper fixation of the rotated septal flap is crucial to achieving long-term postoperative stability. Redistributing the tension of the suture loops into a triangular configuration, known as the kite-shaped method, has proven to be a simple, effective, and reproducible technique.