Chapter 26. Lengthening the Short Nose
Indications: The short nose can be a challenging problem to fix (Figure 26-1). As mentioned in previous sections, manipulation of the radix may aid in changing nasal length. A shallow radix can be deepened, which will move the nasion superiorly and therefore, increase nasal length. Additionally, if the superior dorsum of the nose is low, a graft will also cause the nasion to move superiorly and increase nasal length. If the tip is over-rotated, decreasing tip rotation will increase the length of the nose. However, when the nasion is normal or in cases of a severely short nose, additional procedures are necessary.
Figure 26-1. A. Lateral view of patient with short nose and decreased tip projection. B. Postoperative view of patient after nasal lengthening with anterior septal extension grafts and a columellar strut graft.
Markings: No markings are necessary, but careful analysis and treatment planning is necessary to achieve an optimal result.
Approach: A graduated approach to nasal lengthening is recommended. Because the soft tissue will need to allow the tip to rotate in an inferior direction, wide skin undermining is performed.