The excessively short nose: our systematic approach

The excessively short nose is a challenging dilemma in rhinoplasty. The variability in patient goals and nasal anatomy prevents a one-size-fits-all approach, yet a collection of commonly employed techniques may be considered when approaching an individual nose. This article discusses the common anatomical abnormalities associated with a short nose and reviews the existing literature on techniques to address these abnormalities and how they may be combined to create a unique surgical plan. Typically, correcting a short nose requires an increase in nasal length and projection, along with a decrease in rotation. Achieving this necessitates a complete release of the soft tissue and ligaments from all bony and cartilaginous attachments to allow for skin redraping, as the mucosa and/or soft tissue envelope often pose limitations. Commonly employed techniques include a septal extension graft, anterior septal reconstruction, lower lateral cartilage repositioning with grafting, tip grafts, and occasionally composite grafts.