Correction of difficult short nose by modified caudal septal advancement in Asian patients

Correction of a short nose, defined by a reduced distance from the nasal radix to the tip, has been regarded as one of the most challenging procedures in rhinoplasty. Some short nose cases are too difficult to treat with conventional grafts because of their scanty, flimsy, pliable, or deviated septum or depleted donor supply of septal or conchal cartilage. Although costal cartilage graft may be an option, patients may be reluctant to undergo this invasive surgery.

The author presents his two-year aesthetic results from the treatment of difficult short noses with the modified caudal septal advancement method.

From November 2006 to August 2008, 41 patients (ages 23-59 years) with a short nose were treated with modified caudal septal advancement, with or without extracorporeal septoplasty.

Among the 36 patients who remained for six months to two years of follow-up, 20 patients achieved "excellent" results and 12 patients showed "good" results, both based on nasal lengthening measurements taken by the author. Four patients had only "fair" results. Patients in this last group, including three with overlengthening and one with inadequate elongation, required revision surgery.

In the Asian population, when short-nosed patients present with weak or deviated caudal septums or a limited supply of donor conchal or septal cartilage, the modified caudal septal advancement method can more predictably and efficiently provide a stable nasal base support than the conventional extension grafts, spreader grafts, or extended spreader grafts. The author believes that this technique is a safe, effective, and reliable alternative to costal cartilage grafts in dealing with difficult short noses.