Lengthening the nose: a lesson from craniofacial surgery applied to posttraumatic and congenital deformities.

Various methods of nasal lengthening presented in the literature are discussed, including extensive skin undermining, provision of extra skin by forehead flaps, bone grafts, cartilage grafts to the nasal tip, extensive dissection of nasal lining, and buccal flaps to provide additional nasal lining. This paper describes a method that entails a nasofrontal osteotomy and mobilization of previous fractures in posttraumatic foreshortened noses and a perinasal osteotomy (Le Fort II minus Le Fort I) in congenitally short noses such as seen in Binder's syndrome. Nine posttraumatic and two congenital short noses have been treated in this manner without complication. The procedure draws on experience in craniofacial surgery, where there is a nasofrontal osteotomy and division of lining in extracranial Le Fort II and III osteotomies with insertion of an interpositional bone graft. This method is recommended for markedly foreshortened noses of either traumatic or congenital origin.