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Page 12 of 14 Patel et al. Plast Aesthet Res 2024;11:20 https://dx.doi.org/10.20517/2347-9264.2024.17

It is important to point out that many patients with a short nose require dorsal augmentation as well. When
patients have a low nasal starting point, it can give the impression of a shorter nose. Using a radix graft can
effectively increase the nasal length. In many cases, we may further reduce the dorsum to facilitate the
placement of a new, continuous graft along the entire nasal dorsum. This method was used in many of the
cases presented here .
[34]

MANAGEMENT OF SOFT TISSUE AND MUCOSA
The most significant factors affecting the correction of a short nasal deformity are the constraints in soft
tissue and mucosa. A lack of pliability in vascularized external and internal lining will prevent lengthening
regardless of well-structured grafts and positioning of the osseocartilaginous framework. Preoperative nasal
exercises and skin stretching have been suggested as a means to increase soft tissue mobility through
mechanical and potentially biological creep [35,36] . Despite the likely benefits of this, there are limited data on
techniques and outcomes, which is further complicated by variability in skin types and participation among
patients.

In cases of severe skin damage, short of replacement, the use of nanofat-injected temporalis fascia
purportedly improves skin texture, and we have found this to be anecdotally true. In severe cases of
contracture or lack of viable nasal skin, the use of pedicled interpolated flaps (e.g., melolabial or forehead)
may have to be considered as a means to introduce a healthy soft tissue envelope, though this should be
done in a staged fashion [Figure 16].

POSTOPERATIVE CARE
To our knowledge, there are few studies, if any, that examine outcomes in such patients. Our care for such
patients is centered on minimizing risks of skin necrosis and infection. As such, we advocate for the use of
hyperbaric oxygen therapy (HBO) in these patients. The number and frequency of dives we recommend
varies from 3 postoperative dives to 5 pre and 10 postoperative dives (in cases of severely damaged skin
envelopes). Studies examining the efficacy of HBO are underway. In addition, we recommend 7-10 days of
antibiotic prophylaxis. Infection in these patients can be devastating, as the grafts placed are at risk. Some
[37]
have advocated for more radical antibiotic therapy in revision patients like these, including irrigation .

CONCLUSIONS
The excessively short nose is a complex anatomic dilemma, and its surgical management is dependent on
consideration of etiology and detailed preoperative nasal examination with careful analysis of soft tissue
limitations. In many cases, an increase in nasal length and projection with an accompanying decrease in
rotation is required. Rhinoplasty techniques to achieve these goals often include a septal extension graft or
anterior septal reconstruction, lower lateral cartilage repositioning with strut grafting, tip grafts, and
occasionally composite grafts. Complete release of the soft tissue and ligaments from all bony and
cartilaginous attachments is necessary for skin redraping. In all cases, it is crucial to consider the nose in the
context of the entire face and to understand the surgically achievable results for each individual patient.

DECLARATIONS
Authors’ contributions
Made substantial contributions to the design of this study, along with acquisition and interpretation of the
data: Patel PN, Longino E, Most SP
Contributed to the writing and revision of the manuscript: Patel PN, Longino E, Most SP