A congenital short nose sits high on the face with an upturned tip and nostrils that show more than usual. This page explains why it happens, how the nose can be lengthened and what the family should expect.
A congenital short nose is one that has not grown to its full length, so the tip points upwards and the nostrils are more visible. Lengthening uses cartilage grafts to push the tip down and forward, with extra lining or skin when the covering is tight. Timing is planned around facial growth and any breathing problem.
Nose length comes from the septum in the middle and the cartilages that sit under the tip. When these parts are small or underdeveloped from birth, the whole nose sits shorter than it should. The tip turns up, the nostrils face forwards and the distance from the eyes to the tip looks reduced. Some children also have a low bridge or a flat area between the eyes.
The problem can appear on its own or as part of a wider pattern involving the middle of the face. In these children the skin and the lining inside the nose are often tight as well, so simply pushing the tip down is not enough. Extra tissue has to be created inside before the framework can be lengthened.
Breathing is checked at every visit, because a short nose is sometimes matched by narrow nasal passages. Where breathing is comfortable, correction is usually planned around growth. Where it is not, an earlier procedure may be advised to open the airway first.
Because lengthening a nose means adding structure to it, timing and expectations matter as much as the technique itself.
The nose is measured against the rest of the face, breathing is tested on each side and photographs are taken. A scan is sometimes arranged when the bones under the bridge need review.
The surgeon decides where cartilage will come from. The septum is used when enough is available, and ear or rib cartilage is considered when more length and strength are needed.
Under general anaesthesia, the nose is opened through the nostrils with a small cut across the columella, so the cartilages can be seen and released without tearing the lining.
Cartilage is placed to extend the septum and push the tip down and forward. Extra pieces support the nostril rims so they do not collapse in the new position.
The lining is repaired, the skin is closed and a splint is placed over the bridge. Your child is watched overnight and reviewed within the first week.
The nose feels blocked and swollen and the tip is numb. Pain relief and saline drops are given, and sleeping with the head raised makes the first nights easier.
The splint comes off at review and bruising around the eyes fades. Blowing the nose, swimming and rough play are avoided. School usually restarts in this period.
Breathing is clearer and the new shape starts to read properly. Sport can restart once the surgeon is satisfied that the grafts have settled.
Swelling at the tip is the last to fade, so length and shape keep improving through the first year. Growth is reviewed yearly in younger children.
The nose becomes longer and better balanced, but how much length can be gained is limited by how far the skin over the nose will stretch. Swelling at the tip lasts many months, so the settled shape is judged late rather than early. Grafted cartilage can shift or soften a little with time, and a small further adjustment is sometimes needed. Breathing usually improves where narrow nostrils were part of the problem.
Lengthening asks the skin and lining to stretch, so this is more demanding than simple reshaping. The following are discussed before you decide.
A splint protects the nose at first, and the place the cartilage came from also needs looking after.
Injected material can disguise a contour, but it does not add the structural support that lengthening a nose requires.
The skin covering the nose limits how far it can be lengthened, and pushing past that causes problems.
The nose stays swollen for many months, and the settled shape appears long after that early appearance.
Families come to us for a realistic conversation about how much a short nose can be lengthened, and for surgery timed around the growth of the child.
Cost depends on how much length is needed, where the cartilage is taken from, whether the lining has to be enlarged, the anaesthetic time and the planned hospital stay. Using rib cartilage takes longer than using the septum and is priced accordingly. Where treatment is staged, each stage is quoted on its own. A written estimate is shared after your child has been assessed.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →There is no single band, because the plan can range from a modest graft to a full rebuild using rib cartilage. Anaesthetic time, donor site and hospital stay all matter. You are given a written estimate after the assessment visit.
It is a planned procedure done under general anaesthesia with checks beforehand. Bleeding, infection and graft problems are the main risks, and most children recover without difficulty. Careful timing protects the nose while it is still growing.
One night in hospital is usual, with the splint removed at about a week. Bruising fades over two weeks and school restarts around then. Swelling at the tip settles slowly over several months.
A clear change is usually achieved, though the exact gain depends on how much the skin and lining will stretch. Some length can be lost as healing tightens the tissues, which is why grafts are placed with that in mind.
Children whose nose is clearly short for the face, or who cannot breathe comfortably, are considered. Suitability also depends on how much cartilage is available and on whether other facial surgery is already planned.
Breathing problems are treated earlier. Shaping and lengthening usually wait until facial growth has slowed, often in the teenage years, so the improvement is not undone as the face changes.
The nose is measured and photographed, breathing is checked and any linked condition is reviewed. You hear which grafts would be used, how many stages are likely and what the cost would be, in writing.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
