On the "let-down" procedure in septorhinoplasty

In septorhinoplasty, the classical modified and Cottle's technique may complement each other. The maxilla-premaxilla approach of Cottle can be an utmost tool. Combined "let-down" and "push-down" (LD/PD) procedures can be advantageous in case of: (1) lowering a prominent pyramid while preserving the original profile of the dorsum; (2) lowering a pyramid that, after removal with a rasp knife and scissors, remains too prominent; (3) equalizing a deviated bony vault; and (4) eliminating a cartilaginous hump while preserving the integrity of the upper lateral cartilage. Septum excisions should be done to provide space for LD/PD manoeuvres.