The short nose.

Lengthening the short nose is arguably the most difficult operation in aesthetic rhinoplasty. Open and closed operative techniques can achieve absolute lengthening. In the open technique, maximum lengthening is achieved by releasing the mucoperichondrium, which has to be elevated bilaterally from the septum; releasing the soft tissue between the upper and lower lateral cartilages; and attaching a batten graft to the septum to project the tip cartilages caudally. The closed technique uses a hemitransfixion incision and elevation of the mucoperichondrium bilaterally, followed by attachment of a batten graft. The apparently short nose also can be treated by derotating the tip, correcting the columellar labial angle, and altering the location of the nasion as well as the nasofacial angle.