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.

Contemporary Techniques for Effective Nasal Lengthening

“…Several other excellent reviews are present in the literature. 35,36 However, almost all reports on the topic of nasal elongation focus on algorithms or case examples, with few discrete patient data.…”

Short Nose Lengthening in Primary and Revision Rhinoplasty in Asians

“…For the central compartment (cephalocaudal axis) lengthening, various surgical techniques and grafts have been employed. 6,16,[18][19][20][21][22] We prefer to lengthen the short nose by sandwiching a caudal septal extension graft with 2 extended spreader grafts placed bilaterally in an end-toend manner with the caudal septum (Fig. 1).…”

The Articulated Alar Rim Graft: Reengineering the Conventional Alar Rim Graft for Improved Contour and Support

“…However, in the grossly overresected and severely foreshortened nose, PSAR correction proved far more challenging since the restoration of appropriate nasal length also serves to enlarge the gap between the retracted alar margin and the desired rim position. 24,25 Consequently, all tethers, adhesions, and contractures must be thoroughly disrupted for maximum rim mobilization in these cases. Not surprisingly, PSAR treatment proved most prone to failure in this patient subgroup.…”

“…The SEG is preferred for its unique biomechanical properties that are well suited to precise tip positioning, reliable stabilization of the tip complex, and negligible increases in skeletal bulk. 1,2,4,6,11,24,25,27,28 By uniting the SEG with a strong septal L-strut using rigid suture fixation (with or without splinting grafts), support to the AARG is optimized and the tip complex becomes far less susceptible to unwanted displacement or distortion caused by LCT, by recurrent shrink-wrap contracture, by an overly tight skin closure, and/or by postoperative edema.…”