The face of a child with Down's syndrome is stigmatised by the large tongue, open mouth, saddle nose and epicanthal folds. Operative reduction of macroglossia facilitates nose-breathing, comprehensible speech and eating. Raising the nasal bridge with Cialit-preserved homograft cartilage obliterates the epicanthal folds and conceals the oblique slant of the eyelids. The child should be operated on from the third year onwards.