Maxillonasal dysplasia or Binder's syndrome is an uncommon though easily recognizable congenital condition characterized by a retruded mid-face with an extremely flat nose. The facial deficiencies lead to functional as well as psychological problems. We report on 10 patients with maxillonasal dysplasia whose noses were corrected with onlay costal cartilage grafts using a combined oral vestibular and external rhinoplasty approach. The technique has been used in children as well as adults with promising results. Since the degree of malformation in Binder's syndrome varies significantly surgical correction needs to be tailored individually based on the principles demonstrated. In all patients, minor malocclusion was first treated by orthodontists. Over a follow up period up to 14 years the advancement of the nose was found to be stable, even in lateral cephalograms. The treatment of these patients is a challenge for every surgeon and needs interdisciplinary cooperation.