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Rhinoplasty

All That You Need to Know About Rhinoplasty

All That You Need to Know About Rhinoplasty

What is Rhinoplasty and what are the Indications for Rhinoplasty?

Rhinoplasty is a surgical procedure that is performed to alter the shape of the nose. It is a nose reshaping surgery. This has been performed since time immemorial and is the most common facial cosmetic surgery performed in the world today.

Also referred to as a nose job, this essentially changes the appearance of the nose and improves the overall esthetic appeal of the face. This can be purely cosmetic for the correction of minor deformities. It can also be a life-altering surgery for patients who have nasal deformities arising from cleft lip and palate deformity or trauma to the nasal region.

The popularity of rhinoplasty (nose surgery) has soared over the last 25-30 years with the advent of liberalization of the economy. Improved facial aesthetics leads to greater self-confidence and higher self-esteem for the individual. This automatically leads to a better overall quality of life.

The Development of India as a Preferred Destination for Medical Tourism

India has become a destination of choice for many from around the world due to its high quality of medical care. Many patients flock to the country for cosmetic surgery. In particular, there is a high demand for experienced facial cosmetic surgeons. Another major factor is the economical rhinoplasty cost in India.

Rhinoplasty is one such procedure for which many patients come to our country. This surgery involves alteration of both bone and cartilage. The best rhinoplasty surgeon in India is someone who offers very good cosmetic and functional results for the patient allied with world-class infrastructure and overall level of care. Many surgeons in India perform primary rhinoplasty.

Our hospital is considered to be a center of excellence for rhinoplasty in the country today due to its consistent track record over the years with complete patient satisfaction. Patients refer us to others stating that we are the best hospital for a nose job in India. We are a superspecialty center for the correction of nasal deformities arising from cleft lip and palate deformity.

Best Rhinoplasty Surgeon in India | Surgical Excellence in the Correction of Nasal Deformities

Dr. SM Balaji, Director and Consultant, Balaji Dental and Craniofacial Hospital, Chennai, is considered to be the best rhinoplasty surgeon in India today. This is based on treatment results, patient satisfaction and overall quality of care offered at our hospital in India. He has over three decades of experience in the correction of nasal deformities. Some of the surgical innovations introduced by him have led to improved results and quicker recovery for patients.

Having performed over 25000 rhinoplasty procedures in his career, he is able to intuitively design the nose that best suits each individual patient. The results obtained over the years are a testament to his dexterity and skill. Our hospital is a destination of choice for many international patients who wish to undergo rhinoplasty.

Many patients with nasal deformity not only have compromised esthetics but also compromised function of the nose. The experience of the surgeon is a vital factor in determining the successful outcome of the surgery. Plastic surgeons specialize in this surgery.

Our hospital is a tertiary care center for redo rhinoplasty in India for patients who have had less than optimal results at other surgical centers. Patients with cleft lip and palate deformity who have had compromised results at other treatment centers are offered world-class care at our hospital.

Cosmetic Rhinoplasty for Correction of Nasal Deformities

There are two main surgical techniques for performing rhinoplasty. They are open rhinoplasty and closed rhinoplasty. All incisions are made inside the nose for closed rhinoplasty thus ensuring that there is no visible scarring at the surgical site. Experienced surgeons are able to perform even complex corrective surgery through closed rhinoplasty.

Open rhinoplasty is performed for the correction of deformities with a very complex presentation. This allows greater access to the surgical site and the surgeon is able to directly visualize the structures.

It takes vast experience to be called the best rhinoplasty surgeon in India. With over three decades of experience operating on every possible variety of nasal deformities, our hospital has become synonymous with excellence in rhinoplasty.

Patient Reasons to Opt for Rhinoplasty

Patients can desire to undergo rhinoplasty for a wide variety of reasons. They can range from correction of deformities arising from congenital conditions like cleft lip and palate deformity, nasal deformities caused by trauma or simply cosmetic correction to get the ideal nasal structure.

Classification of Common Nasal Deformities requiring Cosmetic Nasal Surgery

There are a wide variety of nasal deformities. They include a flat nose with a flattened bridge and an extremely wide nose with large nostrils. It could also present as a short nose or an elongated nose. There could be deformities of the tip of the nose like in a parrot beak nose or a crooked nose deformity amongst many others.

Cartilage grafts harvested from the patient are used for the correction of a wide variety of nasal deformities. These grafts are used to augment the bridge of the nose to correct a flat nose, straighten the dorsum of a crooked nose or correct an asymmetrical nose. The nasal cartilages are also trimmed to provide the best possible cosmetic results from the surgery.

Surgery for Broad Nose Correction and Long Nose Correction

Patients who present for this surgery often have nostrils that are excessively wide and reduce the cosmetic appeal of the face. There is also a flattened appearance to the nose due to this deformity. This is corrected by augmentation of the nasal bridge with a graft followed by reduction of nasal width through excision of excess tissue. Longnose correction is obtained by excision of the nasal cartilages to create a nose that is in harmony with the patientโ€™s face.

Correction of Nasal Hump Deformity and Crooked Nose Deformity

Some patients present with a dorsal nasal hump, which reduces the attractiveness of the nose. There is a hump in the nasal bone in these patients. Surgery is performed through the reduction of this nasal hump to straighten the dorsum of the nose. There is a dramatic improvement in appearance following this surgery.

Crooked nose deformity is most often congenital or caused by trauma to the nose. Patients with this deformity are often self-conscious about their appearance and often have breathing difficulties caused by a deviation from the nasal septum. Correction of this deformity often results in a dramatic improvement to their overall quality of life.

Parrot Beak Deformity Correction for Enhanced Facial Esthetics

A parrot beak deformity or Polly beak nose is often characterized by a dorsal hump and a low tip. Its structure resembles that of the upper beak of a parrot. This is mainly a cosmetic procedure. They state that they wish to undergo plastic surgery at the time of presentation. Patients with this nasal appearance are often dissatisfied with their nasal appearance for a long time before presented for corrective surgery.

Though this can be a complicated surgery, the best rhinoplasty surgeon in India who is often vastly experienced in performing such surgeries performs closed rhinoplasty procedures for optimal esthetic results for the patient.

 

Correction of Nasal Deformities arising from Cleft Lip and Palate

Our hospital is a superspecialty center for cleft rhinoplasty with thousands of successful surgeries having been performed over the years. We are recognized as one of the premier surgical centers for this procedure in the world and Dr. SM Balaji is unequivocally the best rhinoplasty surgeon in India for this procedure.

The Best Overall Surgical Center for Rhinoplasty Surgery in India

We pride ourselves in providing total patient satisfaction for those who undergo rhinoplasty at our hospital. Our surgeon who is ably assisted by a highly experienced team of medical and paramedical staff ensures that the results are esthetically pleasing and functionally optimal for the patient.

Bilateral Cleft Lip – Open Rhinoplasty

Bilateral Cleft Lip – Open Rhinoplasty

Open rhinoplasty cost in India

The average cost for open rhinoplasty ranges from  75000 INR to 2,00, 000 Indian Rupees.  This depends upon the complexity of the deformity.

What is Open Rhinoplasty?

Open rhinoplasty, also referred to as external rhinoplasty, is done by making a small incision on the columella, the soft tissue that divides the nose. When under general anaesthesia or twilight sedation, this procedure provides clear access to the underlying bone and cartilage structure. The primary advantage of the open technique is the increased precision for reshaping the nose frame to achieve the desired contouring. The accessible technique is better used when contemplating the revision of the rhinoplasty since the original structure of the nose has already been disrupted.

Dr. SM Balaji can also use an open technique when the patient’s nose is crooked or when the nasal tip projection is significantly reduced (how far the tip sticks out from the face). The open rhinoplasty approach allows for a clearer view of the changes that need to be made, as well as precision and ease of intricate suture and/or grafting. The scar left behind is barely visible and usually disappears over time.

Patient Undergoes Cleft Lip and Palate Surgery as an Infant

The patient is a 19-year-old woman from Ballari in Karnataka, India. She was born with a cleft lip and palate deformity. Her parents had presented to a surgeon in their hometown for corrective surgery. There had always been excessive scarring at the site of surgical repair.

Excessive Scar Formation at the Site of Surgery

The deformity had worsened as she grew older. She had faced considerable bullying while in school and college. These difficult circumstances had made her an introvert. She had very few friends.

There is also an issue of a lack of confidence because of these deformities. The hole in the roof of the mouth had been corrected at the time of initial surgery. Plastic surgeons also perform cleft repair surgery in Western nations. Oral and maxillofacial surgeons also perform facial cosmetic surgery.

Parents Seek Out Best Hospital for Facial Deformity Surgery

It had now worsened to the point where she refuses to leave the house. Her distraught parents decided to get this addressed and consulted family and friends.

They conducted exhaustive Internet research to zero in on the best treatment available. Their search led them to our hospital. They contacted our hospital manager and fixed an appointment for a consultation.

Specialty Center for Facial Cosmetic Surgery in India

Our hospital is a premiere center for facial plastic surgery in India. We specialize in correcting deformities associated with cleft lip and palate defects. We are the regional affiliate of the US-based World Craniofacial Foundation. Orthognathic surgery also results in cosmetic improvement of the face.

Patients from around the world undergo full rehabilitation of craniofacial defects with us. We are a leading center for cleft lip surgery and cleft palate surgery.

Initial Examination and Treatment Planning at our Hospital

Dr. SM Balaji examined her and obtained a detailed history. She had severe scarring of the prolabium. There was an obtuse nasal tip along with an absence of the columella. Her alar base was very broad.

Treatment planning included the creation of a columella using prolabial tissue. The resultant prolabial defect would be then reconstructed using a flap from the lower lip.

He spent time counseling the patient and her parents about what to expect from surgery. It was explained to them that this was a two-step surgery. They were in agreement with the treatment plan and she consented to undergo surgery.

Recreation of Collapsed Columella through Open Rhinoplasty

Markings were first made for a lower lip Abbe flap. A prolabial flap was then raised. An open rhinoplasty was next performed followed by osteotomy of the nasal bone and rearrangement of nasal cartilages. The prolabial tissue was used to recreate the collapsed columella.

Abbe Flap Reconstruction for Prolabial Defect

Attention was next turned to reconstruction of the prolabial defect. A flap of tissue with skin, muscle and intact blood supply was raised from the lower lip. This was next rotated and sutured to the prolabial defect in the upper lip. Care was taken to ensure that there was a patent blood supply to the flap.

The lower lip donor site was then sutured. The lower lip flap remained attached to the upper lip for three weeks. The pedicle was then separated after blood supply has been established from the upper lip.

She and her parents were very pleased with the results of the surgery. There was a tremendous improvement in her facial esthetics. They expressed that she would gain increased levels of self-confidence to face life again.

Surgery Video

 

7 Things you should know about Rhinoplasty

7 Things you should know about Rhinoplasty

What is Rhinoplasty?

Rhinoplasty generally referred to as “nose job,” is surgery to alter the shape of the nose by adjusting the bone or cartilage. Rhinoplasty is one of the most common types of plastic surgery.

Why Rhinoplasty?

People get rhinoplasty to repair their nose after injury, to fix breathing issues or a birth defect, or because they are uncomfortable with the appearance of their nose.

Possible improvements that your surgeon can make to your nose through rhinoplasty include:

  • a change in size
  • a change in angle
  • straightening of the bridge
  • reshaping of the tip
  • narrowing of the nostrils

If your rhinoplasty is performed to enhance your appearance rather than your wellbeing, you can wait until your nasal bone is fully developed. This is around 15 years of age for children.

Boys can continue to grow until they’re a little older. However, if you are having surgery due to impaired breathing, rhinoplasty can be done at a younger age.

Seven Things you should know about Rhinoplasty

  1. Amputation of the nose was a common punishment for criminals in ancient India. This led to debilitating facial deformities with both cosmetic and functional compromise.
  2. Sushruta, the father of plastic surgery, reconstructed the nose through the use of a forehead flap in 800 BC. This technique is still used by surgeons today.
  3. Rhinoplasty is the surgical correction of nasal deformities. It can range from the correction of simple cosmetic deformities to the correction of complex cleft deformities.
  4. There are two types of rhinoplasty, namely open rhinoplasty and closed rhinoplasty. Closed rhinoplasty is the technique of choice as there is no visible scarring after surgery.
  5. Certain nasal deformities require augmentation using rib cartilage grafts obtained from the patient. This is harvested at the time of the same surgery.
  6. Rhinoplasty results not only in cosmetic improvement of the nose but also helps with functional improvements. Difficulty breathing could be due to a nose block, which can be caused by a bent septum to blocked turbinates. These are corrected through rhinoplasty.
  7. Rhinoplasty is extremely technique sensitive and the best results are obtained by vastly experienced surgeons.

How much is the cost of Rhinoplasty in India?

Rhinoplasty charges rely on various factors and range from Rs.70,000 to Rs.2,000,000 in India.

  • The minimum price in India is Rs.70,000.
  • India’s average price is roughly Rs.1,20,000.
  • The overall price in India is up to Rs. 2,000,000.

Rhinoplasty Before After Pictures

Rhinoplasty Before After
Rhinoplasty Before After

Know more about Rhinoplasty

 

Closed Rhinoplasty โ€“ Saddle Nose Correction with Alar Base Reduction

Closed Rhinoplasty โ€“ Saddle Nose Correction with Alar Base Reduction

What is Closed Rhinoplasty?

The closed rhinoplasty technique makes all incisions in the nose, leaving no visible scars. Corrections to the nasal cartilage, bone, and septum are all performed within discreet nasal incisions. The closed rhinoplasty procedure also has the benefit of minimizing recovery times.

Closed Rhinoplasty โ€“ Saddle Nose Correction with Alar Base Reduction

This young man presented our hospital with a  saddle nose deformity, a flattened bridge of the nose, and a wide alar base. He was approached with recovery planning and he consented to surgery.

He first underwent an improvement in the flattened bridge of the nose with a rib grafted at the time of surgery and an excision of the lower crus of the lateral cartilages. This was followed by Weir excision for alar base correction followed by bilateral lateral osteotomy.

He was very pleased with the outcome of the surgery.

Surgery Video

Cleft Rhinoplasty – Nose Correction Surgery

Cleft Rhinoplasty – Nose Correction Surgery

Different nasal forms and the human face

The nose is the most prominent feature in the human face. Evolution down the ages had resulted in a wide variation to human facial features. This ranges from the color of the skin to the shape of the nose or the shape of the chin being different although the DNA is the same.

Environmental factors, diet and a few other factors had influenced this. For example, people from very cold places that received very little sunlight developed light skin and aquiline noses. This served an evolutionary function as less body heat was lost through lighter skin and passage of cold air breathed in through long noses resulted in adequate humidification and warming up of the air as it passed into the trachea.

Likewise, people in hotter regions of the earth developed darker skin and noses with wide open nostrils. This enabled easier cooling down of the body as well as cooling down of the air as it passed in through the broader nostrils.

Functional versus cosmetic rhinoplasty

Functional rhinoplasty is performed when the patient is having problems with breathing or if the deformity of the nose is to a degree that it is affecting their normal functioning in society. This can range from anything from a deviated nasal septum to reconstruction of the nose affected by a cleft lip deformity. A functional rhinoplasty correction also invariably results in improvement in the cosmetic appearance of the nose.

Cosmetic rhinoplasty is performed when the patient has no functional difficulties, but is simply dissatisfied with the appearance of the nose. This is a completely elective procedure and is performed by either plastic surgeons or oral and maxillofacial surgeons. Surgeons from both these specialties undergo years of extensive training in this procedure.

Young woman with a previous history of cleft lip and palate repair

The patient is a young woman from Jharkhand who had undergone repair of her cleft lip and palate as an infant. She had however always had a nasal deformity with a flattened bridge of the nose and a collapsed columella. She had also had nasal breathing problems and snoring during sleep. She desired to undergo cosmetic surgery by a facial plastic surgeon to correct this. This variety of plastic surgery is also performed by oral and maxillofacial surgeons.

Cleft rhinoplasty elsewhere with unsatisfactory results from the surgery

She underwent a rhinoplasty elsewhere two years ago, but was very unhappy with the results of the previous rhinoplasty. She felt that the bone grafting to augment the bridge of her nose was too bulky and her breathing difficulties had worsened. Bone grafting had also been performed to a bony deficiency in the left anterior alveolar region.

Patient referred to our hospital for revision rhinoplasty surgery

She and her parents presented to a local plastic surgeon who advised revision cleft rhinoplasty surgery to correct her problem. He referred them to our hospital as this required a redo rhinoplasty surgery.  This redo rhinoplasty required advanced techniques as the primary rhinoplasty procedure had been improperly performed. The graft placed in the previous surgery had to be removed followed by placement of a newly harvested bone graft. This rhinoplasty procedure is best performed by an experienced rhinoplasty surgeon.

It is only board certified oral and maxillofacial surgeons who perform this surgery in developed countries like the US, UK, Germany and Japan. The nasal bones could have been deformed by the previous surgery. Formation of excess scar tissue could cause this sort of deformity. The nose had to be brought into perfect alignment with the facial features.

Initial examination and treatment planning of the patient

They presented for consultation with Dr SM Balaji, rhinoplasty specialist, who examined the patient and ordered imaging studies. This revealed that the patient had a collapsed columella and the graft at the augmented bridge of the nose had shifted. Merits of an open rhinoplasty versus closed rhinoplasty were considered for the patient. He explained to the patient and the parents that he needed to harvest new bone grafts to correct this deformity. The patient and her parents were in agreement with the treatment plan and consented to surgery.

Harvesting costochondral rib grafts for the surgery

Under general anesthesia, an incision was made through the old scar from the site of the previous bone graft. Two costochondral rib grafts were harvested and a Valsalva maneuver was performed to ensure patency of the thoracic cavity. The incision was closed in layers after confirming this.

Cleft rhinoplasty with placement of columellar strut graft

Attention was next turned to the revision cleft rhinoplasty nose surgery. A vestibular incision was made in the anterior maxilla and the bone graft used to augment the bony depression in the anterior maxilla was exposed. The titanium screw used to fix the screw was removed and the region was further augmented with a rib graft shaped to fill the bony depression in the region.

Attention was next turned to the revision rhinoplasty portion of the procedure. The costochondral grafts were contoured to the correct shape. The previously placed rib graft was removed. An intranasal incision was then made and a graft was tunneled in to give perfect form to the bridge of the nose.

The second costochondral rib graft was then used as a strut graft to raise up the collapsed columella. This was tunneled into the columella through an intraoral approach and secured in place with sutures. This gave perfect form and symmetry to the nose.

The vestibular incision was then closed with sutures and the patient extubated from general anesthesia. Patient and her parents expressed complete satisfaction at the results from the surgery before final discharge from the hospital.

Surgery Video

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