The TABLE Technique: A Targeted Open Approach for Fibrous-dominant Dorsocervical Hump (Buffalo Hump)

BACKGROUND: The TARD technique (involving tumescent anesthesia, sharp cannula release, debulking) achieves satisfactory outcomes in mild-to-moderate fibrofatty dorsocervical humps but shows limitations in the fibrous-dominant subtype. OBJECTIVES: The aim of this study was to introduce a novel approach, named TABLE (involving tumescent anesthesia, border release and liposuction, limited open access, extraction, and excision), to treat fibrous-dominant dorsocervical humps and to evaluate the safety and efficacy of this procedure. METHODS: A retrospective analysis was conducted on 72 patients treated between January 2022 and December 2023. Patients with fibrous-dominant dorsocervical hump were treated with the TABLE approach. Outcomes included surgeon-assessed contour improvement (4-point scale, evaluated by 2 independent plastic surgeons), patient-reported Neck Extension Mobility Score (NEMS), and complications. A 12-month postoperative follow-up was performed. RESULTS: The TABLE technique demonstrated satisfactory outcomes in fibrous-dominant cases, with 93% good-to-excellent outcomes (36% excellent, 57% good) based on the 2 surgeons' evaluations. Excellent interrater reliability was confirmed (Cohen's κ = 0.71). Neck mobility improved, with the Neck Extension Mobility Score decreasing from 2.6 to 1.3, and the overall complication rate was 20.8%. CONCLUSIONS: TABLE is a safe and effective minimally invasive solution for treatment of fibrous-dominant dorsocervical humps, achieving improved aesthetic and functional outcomes. LEVEL OF EVIDENCE: 4: (Therapeutic)For image description, please refer to the figure legend and surrounding text.