Lengthening the short nose.

Abstract

Correction of the aesthetically short nose is one of the most challenging problems in facial plastic surgery. We discuss several techniques aimed at the correction of this problem and propose an algorithm based on the desired effect of the lengthening procedure on tip rotation. Five principal techniques for nasal lengthening are discussed, with figures and cases to illustrate the concepts: (1) the flying buttress graft, which is made up of a single or paired spreader grafts secured to a columellar strut; (2) caudal septal grafts and (3) tip grafts of various shapes; (4) radix grafts placed to elevate the nasion; and (5) interposition grafts placed between the upper and lower lateral cartilages. When the tip is overrotated, small to moderate gains in nasal length may be achieved by a triangular-shaped caudal septal graft or a shield graft that is backed by wedge grafts near the tip. More substantial lengthening and derotation can be achieved by the flying buttress technique or by interposition cartilage or composite grafting between the upper and lower lateral cartilages. With a nasal tip that is adequately rotated or underrotated, nasal lengthening can be achieved by a rectangular-shaped caudal septal graft or by a full-length shield graft. An onlay graft to augment the radix and elevate the nasion to a higher point on the dorsum can be used alone or in combination with a tip or septal graft.