Partial Release of Pyriform Ligament to Prevent Deformities on Keystone Area.

The dorsal hump deformity is common among Western countries based on the nasal structure of Caucasians. Dorsal preservation techniques which leads keeping the keystone area intact can bring positive outcomes such as obtaining aesthetic dorsal lines and better functional results. The positions of soft tissue in the face are supported with a combination of static and dynamic ansatomy. The static support is maintained by ligaments and their associations. Among the ligaments, the pyriform ligament takes a particular role in terms of supporting the alar base, lower lateral cartilages, and nasal tip. In the present research, it was aimed to investigate the beneficial effects of releasing pyriform ligament partially in patients who received dorsal preservation rhinoplasty. The data of the patients who had dorsal rhinoplasty operations for hump deformity were screened retrospectively. A total of 139 patients were included according to inclusion and exclusion criteria and their records were assessed (112 females and 27 males). Twelve months after surgery, the median Rhinoplasty Outcome Evaluation score increased from 52.5 to 91.5 points ( P <0.001). Patient satisfaction was excellent in 86.95% of the included cases according to the Rhinoplasty Outcome Evaluation score. The present study shows a new, suitable, and easy approach for releasing the pyriform ligaments partially and as well as also were left intact. It is suggested that manipulation of the pyriform ligament during push-down and let-down procedures seems to be essential for obtaining a better nasal tip as well as narrowing the nose base and getting better functional outcomes.

Handheld Doppler Detection and Light Illumination for Vascular Mapping in Nasal Reconstruction.

BACKGROUND: The application of the expanded forehead flap in nasal reconstruction has the advantage of being able to provide a sufficient amount of flap and can provide good aesthetic results. For an expanded forehead flap to survive, there must be adequate arterial supply and venous return. Despite this, limited studies have been conducted on preoperative vascular mapping and the design of the expanded forehead flap for nasal reconstruction. In this article, the authors present a technique of hand-held Doppler detection with light illumination for vascular mapping. PATIENTS AND METHODS: The study included patients who underwent total nasal reconstruction with expanded forehead flaps between May 2016 and April 2021. The design of the flap was based on the result of preoperative vascular detection by hand-held Doppler detection assisted by light illumination. RESULTS: A total of 32 patients underwent total nasal reconstruction with an expanded forehead flap. The distal part of the flap became necrotic 1 week after the surgery in 2 patients. Following dressing changes and the administration of antibiotics, the distal flap in these patients survived well. No complications were reported in the long term. CONCLUSIONS: Hand-held Doppler detection combined with light illumination is a convenient and effective preoperative design method for nasal reconstruction with an expanded forehead flap. All flaps survived well in the long term. LEVEL OF EVIDENCE: Level IV.

An Innovative Technique of Presurgical Lip, Alveolus, and Nose Approximation (PLANA) for Infants with Clefts.

The innovative technique of "presurgical lip, alveolus, and nose approximation" (PLANA) offers a new approach within the domain of presurgical infant orthopedics for infants born with cleft lip and palate. Presurgical lip, alveolus, and nose approximation introduces the utilization of the NoseAlign device in conjunction with medical adhesive tapes, designed to approximate and support displaced soft tissue nasolabial structures in patients with cleft, without an intraoral plate. The NoseAlign device, constructed from medical-grade silicone, consists of 2 tubular portions that fit into the nostrils, connected by a columella band. Notably, it also features a wave-shaped and curved horizontal lip band, resting on the upper lip, with elastic clasps for secure attachment to the face with medical adhesive tapes. Presurgical lip, alveolus, and nose approximation therapy employs the NoseAlign device to support the collapsed nasal alar rim and cartilage, the displaced columella, the deviated nasal septum, and the displaced nasal alar base. This innovative approach minimizes the need for frequent office visits, making it particularly suitable for patients residing at a distance from specialized cleft centers. The prefabricated NoseAlign device offers effective support to nasal structures, making it suitable for unilateral and bilateral clefts. Importantly, the absence of an intraoral plate ensures it does not interfere with feeding. Presurgical lip, alveolus, and nose approximation therapy, initiated as early as 1 to 2 weeks, leverages the plasticity of nasal soft tissue and cartilage to achieve the desired nasal form before primary surgery. Although presurgical lip, alveolus, and nose approximation therapy does have some limitations, particularly in cases of medially collapsed alveolar segments, its simplicity, universal applicability, and patient-friendliness make it a promising technique in the presurgical infant orthopedics field.

Poly Lactic-co-Glycolic Acid Absorbable Plate Graft for Secondary Rhinoplasty in Asian Patients with Unilateral Cleft Lip Nose Deformity.

INTRODUCTION: In secondary cleft lip and nasal deformity (CLND) correction, structural grafts are commonly used to control the nasal tip and restore the symmetry of the ala. However, the septal cartilage in Asians often weak and small. Biocompatible absorbable materials are alternatives to autologous grafts. This study assessed the surgical outcomes and complications of poly lactic-co-glycolic acid (PLGA) plate grafts in secondary CLND correction. METHODS: This study was retrospectively analyzed for patients who underwent secondary rhinoplasty for unilateral CLND correction between March 2015 and November 2020. Using open rhinoplasty, the PLGA plate was grafted as a columellar strut. Clinical photographs taken at the initial (T0) and follow-up visits (T1: short-term, T2: long-term) were analyzed and anthropometric parameters, such as nostril height and width, dome height, and tip height, were measured. RESULTS: Twenty-four patients were included in this study. The mean T1 and T2 periods were 1.0 ± 0.4 and 15.5 ± 3.1 months, respectively. The nostril height ratio increased from 0.78 ± 0.12 at T0 to 0.88 ± 0.08 at T1 and 0.86 ± 0.09 at T2 (p < 0.001; Relapse ratio -2.6 ± 6.7%). The tip height ratio increased from 0.60 ± 0.07 (T0) to 0.66 ± 0.05 (T2) (Relapse ratio -3.7 ± 3.0%). CONCLUSIONS: The PLGA plate graft provided stable nasal tip projection and alar symmetry without major complications. It can be a good option for patients lacking available septal and concha cartilages or apprehensive of additional scarring.

Maxillary and total nasal reconstruction with a scapulo dorsal perforator flap.

Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.

Case report of bilateral middle ear effusion requiring myringotomy and tube placement following inferior U-shaped nasopharyngeal flap elevation for endonasal odontoidectomy: investigation of causality.

We describe a patient with symptomatic os odontoideum and a previous history of C1-2 wiring who underwent successful treatment with a staged endonasal odontoidectomy and C1-2 revision of instrumentation. Access to the odontoid process was gained through the endonasal corridor using an inverted U-shaped nasopharyngeal flap (IUNF). Post-operatively, the patient experienced resolution of her presenting neurologic symptoms but developed conductive hearing loss secondary to bilateral middle ear effusion, requiring bilateral myringotomy and tube placement 3 months post-operatively. We hypothesize this dysfunction may have resulted from surgical edema, packing buttressing the IUNF, or some combination thereof. In this manuscript, we review the evolution of the nasopharyngeal exposure for odontoidectomy and whether an IUNF may predispose to this complication.

Forked Paramedian forehead flap combined with nasolabial flap for pre-radiation coverage of exposed maxilla in the Total Rhinectomy patient.

Total rhinectomy is ontologically necessary for large and locally invasive carcinomas of the nasal cavity owing to the complex three-dimensional structure of the nose. Reconstruction options include singular or combined options of local tissue rearrangement, free flap reconstruction, and prosthetic reconstruction which may be delayed in the setting of post-ablative radiation therapy. If significant bony exposure is present prior to radiation, there is a substantial risk of osteoradionecrosis and the ensuing sequalae. In these cases, coverage of the bony defect may be advantageous prior to radiation and final reconstructive treatment. We present a case of a total rhinectomy defect for squamous cell carcinoma in a patient who had significant bony exposure prior to radiation which was resurfaced with a combined forked paramedian flap and nasolabial flap. The patient went on to be treated with a full course of radiation and had planned for a post-treatment nasal prosthesis.

Analysis of select esthetic nasal parameters in virtually planned orthognathic patients.

PURPOSE: Bony changes after orthognathic surgery are always followed by changes of the overlying soft tissues. Therefore, morphologic changes of the nose may be expected after procedures involving the maxilla. The purpose of this study was to evaluate the changes in the nasal region due to orthognathic surgery using computed tomography (CT) images of virtually planned patients. METHODS: 35 patients who underwent Le Fort I osteotomy, with or without bilateral sagittal split osteotomy, were included. 3D measurements on preoperative and postoperative images were performed and analyzed. RESULTS: The results revealed that aesthetically acceptable results can be achieved by orthognathic surgery alone. CONCLUSIONS: According to the results of this study, it can be concluded that it is best to reserve decisions on rhinoplasty to the post-orthognathic period.

Comparison of the Effectiveness Between Conventional and Modified Cinch Suture Techniques in LeFort I Osteotomy: A Systematic Review and Meta-Analysis of Randomized Control Trials.

BACKGROUND: LeFort I osteotomy changes the morphology of the nose. The cinch suture has been proven to prevent the increase in nasal base and alar width. Different types of cinch sutures have been proposed. However, their effectiveness is unclear. AIM AND OBJECTIVES: The aim of this study was to compare the surgical outcomes between conventional and modified cinch techniques through a systematic review and meta-analysis of randomized control trials (RCTs). MATERIAL AND METHODS: We performed systematic search from Embase, PubMed, and the Cochrane Library according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement up to March 2021. The surgical techniques of different cinch sutures were reviewed, and the outcomes of nasal alar width and alar base width were compared between modified and conventional methods. RESULTS: A total of 4 eligible RCTs were included in this meta-analysis. Pooled data showed no significant difference in alar base width change between modified and conventional methods (mean difference, -0.37; 95% confidence interval, -1.32 to 0.57; P = 0.44). Pooled data of 3 studies also showed no significant difference in nasal alar width change (mean difference, -0.11; 95% confidence interval, -1.18 to 0.95; P = 0.83). CONCLUSION: Based on the current data pooled from the available RCTs, no significant difference was found between the conventional cinch technique and the modified technique.

The Assessment of External Nasal Valve Efficiency After Le Fort I Surgery.

BACKGROUND: The present study investigated how external nasal valve function is affected after Le Fort I osteotomy using external nasal valve efficiency (ENVE) index. MATERIALS AND METHODS: Twenty-one patients who underwent Le Fort I osteotomy with or without mandibular osteotomy were included in the retrospective study. Preoperative and postoperative standardized videos of basal view of the nose during breathing were recorded, and 2 screenshots were taken, 1 in the resting position and the other after deep inspiration. External nasal valve efficiency was calculated at preoperative and postoperative periods for each patient. RESULTS: Of the 21 patients, 12 were women and 9 were men (mean age, 26.63 ± 8.20 years). The mean ENVE index was 0.75 ± 0.16 for the preoperative period and 0.82 ± 0.17 for the postoperative period. There was a significant difference between these values ( P = 0.002). When the correlation of the ENVE with maxillary movements was analyzed, the ENVE was negatively affected by maxillary impaction ( P = 0.011, r = -0.540). CONCLUSIONS: These findings imply that Le Fort I osteotomy positively affects the ENVE index. However, because of the antagonistic relation between maxillary impaction and ENVE, higher maxillary impaction amounts or isolated maxillary impaction should be carefully planned in patients with low ENVE index.

Does Early Referral Lead to Early Repair? Quality Improvement in Cleft Care.

BACKGROUND: Cleft lip and palate is the most common congenital defect of the head and neck, occurring in 1 of 700 live births. Diagnosis often occurs in utero by conventional or 3-dimensional ultrasound. Early cleft lip repair (ECLR) (<3 months of life) for unilateral cleft lip (UCL), regardless of cleft width, has been the mainstay of lip reconstruction at Children's Hospital Los Angeles since 2015. Historically, traditional lip repair (TLR) was performed at 3 to 6 months of life ± preoperative nasoalveolar molding (NAM). Previous publications highlight the benefits of ECLR, such as enhanced aesthetic outcomes, decreased revision rate, better weight gain, increased alveolar cleft approximation, cost savings of NAM, and improved parent satisfaction. Occasionally, parents are referred for prenatal consultations to discuss ECLR. This study evaluates timing of cleft diagnosis, preoperative surgical consultation, and referral patterns to validate whether prenatal diagnosis and prenatal consultation lead to ECLR. METHODS: Retrospective review evaluated patients who underwent ECLR versus TLR ± NAM from 2009 to 2020. Timing of repair, cleft diagnosis, and surgical consultation, as well as referral patterns, were abstracted. Inclusion criteria dictated: age < 3 months for ECLR or 3 to 6 months for TLR, no major comorbidities, and diagnosis of UCL without palatal involvement. Patients with bilateral cleft lip or craniofacial syndromes were excluded. RESULTS: Of 107 patients, 51 (47.7%) underwent ECLR whereas 56 underwent TLR (52.3%). Average age at surgery was 31.8 days of life for the ECLR cohort and 112 days of life for the TLR cohort. Furthermore, 70.1% of patients were diagnosed prenatally, yet only 5.6% of families had prenatal consults for lip repair, 100% of which underwent ECLR. Most patients were referred by pediatricians (72.9%). Significance was identified between incidence of prenatal consults and ECLR (P = 0.008). In addition, prenatal diagnosis was significantly correlated with incidence of ECLR (P = 0.027). CONCLUSIONS: Our data demonstrate significance between prenatal diagnosis of UCL and prenatal surgical consultation with incidence of ECLR. Accordingly, we advocate for education to referring providers about ECLR and the potential for prenatal surgical consultation in the hopes that families may enjoy the myriad benefits of ECLR.

The impact of passive alveolar molding vs. nasoalveolar molding on cleft width and other parameters of maxillary growth in unilateral cleft lip palate.

OBJECTIVE: Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared. MATERIAL AND METHODS: We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured. RESULTS: Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle. CONCLUSIONS: NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth. CLINICAL RELEVANCE: The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.

Assessing the Nasal Midline in Rhinoplasty: How Good Are We?

BACKGROUND: The challenge of assessing nasal alignment and asymmetry can contribute to high revision rates in rhinoplasty. Comparing to a validated computer algorithm for nasal alignment, the accuracy with which plastic surgeons can assess deviation of the nasal midline from the facial midline was measured. METHODS: Using 20 faces from the Binghamton University 3-dimensional face database, deviation was evaluated from facial midline of the middorsal line for the upper, middle, and lower thirds of the nose. Surgeons were asked to assess extent of deviation from facial midline for each third of the nose using a linear analog scale. Spearman correlations were performed comparing the surgeons' results to the algorithm measurements. Eleven residents and 9 consultant surgeons were tested. RESULTS: Surgeons' assessment of deviation correlated poorly with the algorithm in the upper third ( r =0.32, P <0.0001) and moderately in the middle third ( r =0.49, P <0.0001) and lower third ( r =0.41, P <0.0001) of the nose. No difference in accuracy was found between trainee and consultant surgeons ( P =0.51), and greater experience (>10 y performing nasal surgery) did not significantly affect performance ( P =0.15). The effect of fatigue on the accuracy of assessment was found to be significant ( P =0.0009). CONCLUSIONS: Surgeons have difficulty in visually assessing the 3-dimensional nasal midline irrespective of experience, and surgeon fatigue was found to be adversely affect the accuracy of assessments.

Dorsal Augmentation With the Dorsal Extension Spreader Graft.

Spreader grafts traditionally are used to improve airflow through opening the internal nasal valve, as well as enhance the cosmetic appearance of the nose. The graft's versatility proves useful in surgical correction of several nasal profiles by enhancing dorsal aesthetic lines and by maintenance of the nasal pyramid at midline. The authors describe a modified spreader graft that adds an additional benefit of dorsal augmentation in patients with underprojected or saddle noses. This technique utilizes harvested septal cartilage and fixation of the graft that extends beyond the septal and upper lateral cartilage dorsal border to improve nasal dorsum height. Patients who received this operative technique by the senior author were identified and their operative courses and surgical outcomes were analyzed. Case examples are provided to illustrate indications and outcomes. This grafting technique allows for improved functionality, defined dorsal aesthetic lines, changes in nasal width, and a more balanced profile in patients with underprojected noses.

An Innovative Method for Nasal Alar Reduction Surgery Based on the Equilateral Triangle Design Theory.

At present, there is no unified and accurate method to design the amount of tissue to be removed in alar reduction surgery. The authors present the experience that the crescent-shaped alar resection is based on the innovative equilateral triangle theory. It can accurately estimates the amount of alar tissue to be removed and conforms to the 3-dimensional esthetic concept of the nose. Followed up for 6 to 12 months, took 6 and 12 months postoperative photos, measured the postoperative nasal base width, and conduct a questionnaire satisfaction survey. The width of the nasal base was reduced by an average of 4.4±2.1 mm. The mean visual analog scale score showed: 4.8±1.6 before operation and 7.6±1.2 after the operation ( P <0.05), which revealed satisfactory patient outcomes. This method provides a new idea for the evaluation of nasal alar resection volume and is worthy of clinical application.

Lessons Learned From Using Silicone Implants in Clean-Contaminated Regions of the Face.

Augmentation rhinoplasty changes the shape of the nose using implanted material. In the 1980s, nasal implantology began to favor silicone over traditional autologous grafts because the synthetic material presented exciting benefits. However, long-term complications of nasal silicone implants have since emerged. This has necessitated the introduction of safe and effective materials. Despite an overwhelming transition to the use of improved implants, craniofacial surgeons will likely continue to see the consequences of silicone implant use as long-term complications arise in the innumerable patients who have had this procedure worldwide.

Retrospective Evaluation of a Novel Nasal Tip Suture Technique.

Nasal tip surgery is a crucial aspect of rhinoplasty in which suture techniques play a significant role. Early suturing techniques focused primarily on repositioning alar cartilage remnants after they had undergone significant resection. The size, contour, and orientation of the medial and lateral crura are primary factors in creating a tip shape. In this review, we retrospectively evaluated obliquely oriented dome sutures with triangular dome resection that was performed in 540 rhinoplasty cases at Yunus Emre Hospital between 2015 and 2020. Dome-defining sutures were placed, and a triangular cartilage resection was performed. Subsequently, oblique sutures were placed to achieve the desired lateral cartilage position. Objective assessment of postoperative results (Objective Rhinoplasty Outcome Score), patient satisfaction assessments, and nasal examinations were conducted. The objective assessments of the esthetic results showed a significant improvement, with a mean score of 3.6, which represents a good to excellent outcome. Most patients were subjectively satisfied with the surgical outcomes of rhinoplasty. No serious complications, such as infection, recurrence of deviation, nasal obstruction, or esthetic problems such as dorsal irregularities, were observed after surgery. Overall, suturing techniques play an important role in determining the nasal tip shape. Our technique is beneficial for maintaining a favorable lateral crural position, leading to improved patient satisfaction.

Effect of One-Stage Bilateral Cleft Lip, Nose, and Alveolus Repair Following Nasoalveolar Molding on the Premaxilla Position at Preadolescence: An 8-Year Retrospective Study.

BACKGROUND/PURPOSE: This paper describes the changes in maxillary arch morphology in infants with bilateral cleft lip and palate (BCLP) following nasoalveolar molding (NAM) and with follow up to assess the need for secondary alveolar bone grafting (ABG) and premaxillary repositioning surgery at preadolescence. METHODS/DESCRIPTION: Treatment records of infants with BCLP treated with NAM between 2003 and 2013 were reviewed. Patients with complete BCLP who underwent NAM and had complete sets of maxillary casts at T 0 pre-NAM (mean = 27 days), T 1 post-NAM (mean = 6 months and 5 days), and T 2 before palate surgery (mean = 11 months and 15 days) were included. The sample comprised 23 infants (18 male, 5 female). Casts were digitized and analyzed using three dimensional software. The need for secondary ABG and premaxillary repositioning surgery was assessed at preadolescent follow-up (mean = 8.3 years). RESULTS: Cleft width was reduced on average by 4.73 mm (SD±3.15 mm) and 6.56 mm (SD±4.65) on the right and left sides, respectively. At T 1, 13 (56.52%) patients underwent bilateral gingivoperiosteoplasty (GPP), 8 (34.78%) patients unilateral GPP, and 2 patients (8.7%) did not undergo GPP. 34/46 clefts sites (73.91%) underwent GPP while 12 (26.08%) did not. At preadolescent follow-up of 19 patients, 7 patients (36.84%) did not need ABG on either side, 8 (42.10%) needed ABG on 1 side, and 4 (21.05%) needed ABG on both sides. None of the patients needed premaxillary repositioning surgery. CONCLUSIONS: Nasoalveolar molding treatment significantly improves the position of the premaxilla before primary repair, and there is a significant reduction in the need for secondary ABG and premaxillary repositioning surgery at preadolescence.

Nasal Tip and Alar Groove Plasty Through External Nasal Cutting in Asians: A Clinical Study.

OBJECTIVE: Nasal tip hypertrophy is common in Asians, and its reshaping is very critical in rhinoplasty. For patients who refuse any implant placed in the nose, there are limited options for tip reshaping. Herein, we introduce a new procedure of nasal tip and alar groove plasty through external nasal cutting in Asians. METHODS: A total of 20 patients who had hypertrophic nasal tip and refused to have any implants were included in this study. They were performed this procedure of nasal tip and alar groove plasty through external nasal cutting. The authors carefully reviewed the patients' medical records and preoperative and postoperative photographs. Self-reported satisfactions of patients with the scar morphology and correction effect were assessed at postoperative every follow-up using a questionnaire survey. RESULTS: All of the patients' procedures were completely successful, and the hypertrophic nasal tip was improved. In the long-term postoperative follow-up, the patients' wound showed no abnormalities such as scar contracture deformity, scar bumps, and nasal deformation. In 1 patient, the nasal wound developed significant scarring, and we performed reoperation to remove the superficial scar tissue. Surgical scars in the remaining patients were not obvious. Eight patients (8/20) reported "very satisfied" with scar shape and nasal tip shape improvement results, and 10 patients (10/20) reported "satisfied" with the outcomes. CONCLUSIONS: This procedure of nasal tip and alar groove plasty could be an alternative for making the nasal tip more refined. However, the surgical indications for this procedure need to be strictly limited to specific patients. LEVEL OF EVIDENCE: Level IV.

Short Nose Lengthening in Primary and Revision Rhinoplasty in Asians.

BACKGROUND: Surgical techniques and graft materials are important factors for short nose lengthening in both primary and revision rhinoplasty in Asian patients. Other subunit of the nose need to be improved as well to achieve aesthetic perfection. MATERIALS AND METHODS: A cohort of 98 patients who underwent primary and revision rhinoplasty for moderate to severe short nose deformity from January 1, 2019, to December 31, 2020, were enrolled. Nasal elongation was achieved via an open rhinoplasty approach using autologous costal cartilage exclusively for grafting. Aesthetic outcomes were evaluated by anthropometric measurement and satisfaction assessment from patients and physicians. RESULTS: The mean duration of follow-up was 10.6 months. In both primary and revision cases, nasal length relative to preoperative measurements increased significantly, while nasal tip projection did not differ significantly. Columellar-facial angle and nasofrontal angle decreased significantly in both groups. Both physicians and patients reported improvement in aesthetic outcomes. CONCLUSIONS: Aesthetic satisfaction was reported from both patients and physicians. Autologous costal cartilage is an ideal graft material that offers strong structural support. Caudal septal extension graft using autologous costal cartilage sandwiched by extended spreader grafts achieve satisfactory lengthening of the central compartment and also increase nasal tip projection and rotation.