Conclusion: This technique shows a surgical approach with low morbidity, short surgery time, and low blood loss. It allows optimal resolution of severe hypoplasia of the middle third of the face with longterm stability. It avoids the use of grafts and osteosynthesis material. By not including the nasal pyramid in the osteotomy design, the size, position, and nasofrontal angle in patients with adequate facial balance is maintained. If nasal correction is necessary, a second surgery may be done. In cases of asymmetrical hypoplasia of the middle third, this osteotomy shows great versatility and can be done unilaterally and/or simultaneously combined with other distractions. (C) 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.