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Surgery

Facial Asymmetry Correction with Fat Graft for Parry Romberg Disease

Facial Asymmetry Correction with Fat Graft for Parry Romberg Disease

What is Facial Asymmetry?

When you examine your face in photos or the mirror, you can find that your features are not perfectly aligned. One ear may begin higher than the other, or one side of your nose may have a sharper point.

Asymmetry refers to having features that do not exactly mirror one another on both sides of the face.

Almost everybody has a degree of facial asymmetry. However, some instances of asymmetry are more obvious than others. Asymmetry may be caused by injury, aging, smoking, and other causes. Mild asymmetry that has always existed is considered natural.

However, recent, visible asymmetry can indicate the presence of a serious condition such as Bell’s palsy or a stroke. Continue reading to learn more about the causes of an asymmetrical face, as well as testing and treatment options.

What is Parry–Romberg syndrome?

Parry–Romberg syndrome (PRS) is a rare disorder that causes progressive shrinkage and degeneration of the tissues beneath the skin, typically on one side of the face (hemifacial atrophy), but also affecting other parts of the body.

Facial Asymmetry Correction with Fat Graft for Parry Romberg Disease

This patient first noticed a developing asymmetry due to gradual atrophy of his left lower jaw a few years back and had been diagnosed with Parry Romberg disease. Parry Romberg disease could have a varied etiology including viral, traumatic, nervous system abnormalities or as an autoimmune disease.

He presented to our hospital seeking correction of his facial asymmetry. He was diagnosed to have atrophy of subdermal fat in the left mental/submental region. A full-thickness dermal fat graft was harvested from his inguinal region. This was then inserted into a submental pocket created at the region of the atrophy.

Minimal overcorrection was performed to allow for slight resorption of the fat graft. He was very pleased with the results of the surgery.

Fibrous Dysplasia of Zygoma and Orbit

Fibrous Dysplasia of Zygoma and Orbit

Young Man Notices Gradual Development of Facial Asymmetry

The patient is a 26-year-old man from Thalassery in Kerala, India. He has had a slowly progressing facial asymmetry for many years now. There was a gradually developing swelling of the right midfacial region.

A biopsy had been obtained and he had been diagnosed with fibrous dysplasia. He had chosen to ignore it as it was not causing him any functional difficulties.

Disfigurement caused by Fibrous Dysplasia and its Probable Etiology

Fibrous dysplasia is a rare disorder of the bone where normal bone is replaced by fibrous tissue. There is an overgrowth of this fibrous tissue, which results in progressive facial disfigurement. The bone is also weakened by this fibrous tissue.

It is thought to result from a genetic mutation at birth but is not hereditary. There is a dull ache in the region of the affected bone. Fractures are also common when it affects the limb bones. The only treatment available is the surgical removal of the fibrous tissue.

Patient Decides to Undergo Surgical Correction of his Deformity

The growth has now progressed to the point where it is causing self-esteem problems for the patient. He was beginning to avoid social interactions because of the extreme facial disfigurement. His parents researched the internet for the best hospital to get this addressed. They also made widespread inquiries regarding the same.

Our hospital is a premiere center for facial plastic surgery in India. Many patients have undergone facial cosmetic surgery and facial reconstructive surgery at our hospital. He and his parents zeroed in on our hospital for his fibrous dysplasia surgery.

Our hospital stringently follows protocols laid down by the American Society of Plastic Surgeons. We also conform to the guidelines laid down by the European Society of Aesthetic Plastic Surgery. Many referrals are made from centers in the European Union to our hospital for correction of facial deformities.

Patients from around the world come to us for reconstructive plastic surgery and facial asymmetry surgery. We utilize advanced facial biometric systems for facial asymmetry correction. Facial implants can be utilized when there is a bony deficiency causing facial asymmetry.

Initial Consultation and Treatment Planning at our Hospital

Dr. SM Balaji, facial cosmetic surgery, examined the patient and spoke with him at length. Biopsies and imaging studies were ordered including CT scans. This revealed a diagnosis of fibrous dysplasia of zygoma and orbit along with the involvement of the temporal bone.

The fibrous overgrowth had caused gross disfigurement of both bones. Our hospital also offers comprehensive imaging services including magnetic resonance imaging (MRI) scan and bone scan.

He explained the surgical treatment process and the cosmetic improvement to the patient. All queries raised by the patient and his family were addressed. The patient and his parents expressed understanding and consented to surgery.

A 3D stereolithographic model of the patient’s skull was obtained. The fibrous overgrowth was studied and presurgical analyses were performed. It was then decided to proceed with surgery.

Surgical Removal of Fibrous Overgrowth

The affected regions of the zygoma and temporal bone were approached through a hemicoronal incision. No other approach would enable satisfactory removal of the fibrous tissue. Surgery progressed through dissection of the galea and temporal fascia. Care was taken to also preserve blood supply to the temporalis muscle to prevent any postsurgical atrophy.

The frontalis and orbicularis oculi branches of the facial nerve were protected throughout the surgical procedure. Dysplastic fibrous overgrowth was removed meticulously. Normal bony contour was established through the removal of the excess tissue. This would restore symmetry to his face.

The fascia was sutured with retraction of the temporal muscle after adequate removal. This was to ensure that there would not be a hollowed-out appearance to the region. The incision was finally closed with staples.

Postsurgical Improvement in Facial Appearance

The patient and his parents were very happy with the results of the surgery. There was a tremendous improvement in the cosmetic appearance of the face. Improvement in the patient’s self-confidence was apparent shortly after surgery.

He and his parents expressed their total satisfaction with the treatment process at our hospital.

Surgery Video

Orbital Dystopia Surgery with Medial Canthopexy and Rhinoplasty

Orbital Dystopia Surgery with Medial Canthopexy and Rhinoplasty

Orbital Dystopia Surgery

One of the most common clinical symptoms of craniofacial malformation is orbital dystopia. The concept dystopia refers to the orbits’ mono- and bilateral asymmetry in at least one of the three-dimensional planes. The clinical examination of the patient is used to make the diagnosis, which is supported by diagnostic instruments such as teleradiography in both normal projections, axial computed tomographic (CT) scans at a rate of 1:1 via the neuro-orbital plan, and three-dimensional CT.

A young man with Grievous Facial Injuries from Road Traffic Accident

This is a 24-year-old man from Ranchi in Jharkhand, India. He had been involved in a horrific road accident. There was also blindness caused by the loss of his left globe. This had resulted in left-sided facial fractures involving his middle facial region. These fractures involved many bones causing asymmetry.

There was the involvement of his orbital bone, nasal bone, zygoma and maxilla. He had undergone a series of surgeries in various hospitals. These had left him with a facial asymmetry and severe orbital dystopia.

He descended into a depression because of the turn of these events. His worried parents had consulted far and wide for the best hospital to address his problems. They were referred to our hospital by a leading plastic surgeon in their hometown. They contacted our hospital manager and fixed an appointment for a consultation.

Board-certified facial cosmetic surgeons perform these surgeries in Western nations. Oral and Maxillofacial surgeons who are also cosmetic surgeons perform these in India.

Leading Center for Facial Trauma Surgery In India

Our hospital is a leading center for redo facial trauma surgery in India. Many patients with complications arising from surgery performed elsewhere present to our hospital. Our hospital serves as a tertiary referral center for craniofacial surgery in Asia.

We are a specialty center for prosthetic eyeball surgery in India. Our in-house prosthetic laboratory provides custom-made shells to many centers around the country.

Specialty Center for Redo Facial Cosmetic Surgery

Dr SM Balaji, facial cosmetic surgeon, examined the patient and obtained imaging studies. The patient had gross facial asymmetry. This was caused by the malunion of the facial fractures. There was a widening of the canthal bay due to the nasoorbitoethmoidal fracture.

He also had a depressed nose due to a fracture of the nasal bone. CT scans were also obtained for the evaluation of the cribriform plate. Treatment planning was presented to the patient and he consented to surgery.

Facial Asymmetry Correction Performed in our Hospital

A costal cartilage graft was first harvested to augment the depressed nose. The sites of the malunited fractures were then accessed. The plates from the previous surgeries were also removed.

A Titanium mesh with Medpor was then introduced through the subconjunctival incision. This resulted in the reconstruction of the fractured orbital floor. A lateral canthopexy was then performed for the correction of the canthal bay deformity.

This was next followed by augmentation rhinoplasty. The costal cartilage graft was used to raise the bridge of the flat nose. This resulted in the correction of his nasal deformity. An orbital conformer was then placed at the conclusion of the surgery. This resulted in the correction of his facial deformities.

The patient expressed his satisfaction with the results of the surgery. His parents too conveyed their gratitude before final discharge from the hospital.

Surgery Video

Facial Paralysis Surgery – Static Suspension

Facial Paralysis Surgery – Static Suspension

Facial Paralysis Surgery in India

What is Facial Paralysis?

Bell’s palsy can be caused by a viral infection. It almost never happens more than once.
Bell’s palsy is described by muscle weakness, which causes one-half of the face to droop.
Bell’s palsy normally goes away on its own after six months. Physiotherapy can help prevent muscles from contracting indefinitely.

Patient with Facial Paralysis seeks Solution for his Problem

The patient is a 27-year-old male from Rourkela in Odisha, India. He has had long-standing facial paralysis on the right side of his face. There was a drooping of the corner of the mouth on the affected side. He had tried a variety of medical treatments, which failed to address his problem.

Referral to our Hospital for Treatment of his Condition

This had left him feeling very frustrated. Seeking a solution, he had visited a cosmetic surgeon in his hometown. He underwent a dynamic reanimation with temporalis reanimation surgery. There was no improvement in his facial paralysis and this surgery was a complete failure.

An internet search for the best facial paralysis surgery hospital in India had brought up our name. Having satisfied himself with the search results, he contacted our hospital manager and fixed an appointment for an initial consultation.

Specialty Center for Facial Cosmetic Surgery in India

We are a leading center for facial paralysis surgery in India. Our hospital is well known for facial plastic surgery in India. We are a specialty center for the correction of drooping mouth. This most commonly is caused by facial paralysis.

We offer advanced treatments with the latest innovations from around the world. The cost of lip paralysis surgery in India is a fraction of what it costs in the West. Board-certified plastic surgeons often perform these surgeries in Europe and Japan.

Regaining Movement in Paralyzed Face

Facial reanimation surgery is also performed in our hospital. Patients come from around the world for this surgery. The patient regains the ability to emote following this surgery.

Surgery for Correction of Facial Deformities

Many conditions lead to facial asymmetry. The asymmetry can either be isolated to the soft tissue like in facial paralysis. It can also be due to underlying bony deformities. Facial palsy is caused by loss of innervation to facial muscles on one side supplied by the facial nerve.

Viral infections are a frequent cause of facial palsy (Bell’s palsy), but a majority of such cases recover spontaneously. We also specialize in facial asymmetry surgery. Scores of patients have been rehabilitated after undergoing surgery in our hospital.

Initial Consultation at our Hospital

Dr. SM Balaji, facial cosmetic surgeon, examined the patient. He obtained a detailed history and spoke with the patient at length. Treatment planning was discussed with the patient. The mechanism of static suspension surgery was explained to him.

He was encouraged to ask questions and clear his doubts. Once all his questions were answered to his fullest satisfaction, he expressed understanding and consented to undergo surgery.

Successful Cosmetic Rehabilitation of Facial Paralysis

Surgery commenced with harvesting a fascia lata graft from the thigh. The incision was closed with sutures once the graft was harvested. Attention was next turned to the face. An elliptical incision was made over the nasolabial fold. Orbicularis oris muscle fibers were then identified.

The fascia graft was tunneled up to the zygomatic arch. The graft was then looped around the arch to form a circumzygomatic sling. Care was taken to ensure that there was no damage to any nerves or vessels.

Both ends of the fascia lata sling were then sutured to the orbicularis oris. There was a good improvement of facial symmetry following this procedure.  A lateral tarsorrhaphy was also performed as his cornea was getting ulcerated due to his inability to oppose the left eye.

Total Patient Satisfaction with Results of Surgery

The patient was very happy with the results of the surgery. He expressed his gratitude to the surgical team before discharge from the hospital.

Surgery Video

Facial Asymmetry Correction by BSSO Surgery

Facial Asymmetry Correction by BSSO Surgery

Facial Asymmetry Surgery by bilateral sagittal split osteotomy (BSSO)

Patient with a Progressive Increase in Lower Jaw Size

The patient is a 21-year-old male from Durgapur in West Bengal, India. He has always had a very large lower jaw in comparison to his upper jaw. There was also a slight deviation of the lower jaw to the right. This resulted in a mild asymmetry of his lower face.

A bilateral sagittal split osteotomy (BSSO) is the surgery of choice for reducing a large lower jaw. A receded lower jaw is advanced using distraction osteogenesis. Internal distraction is safer and preferred over external distraction. The open bite caused by upper jaw abnormalities is corrected through maxillary osteotomy.

Size discrepancy between the jaws can lead to a lot of functional difficulties. Speech is altered and eating patterns are also altered. Left unaddressed, this could possibly also lead to problems with the temporomandibular joint (TMJ). Cosmetic compromise is another important aspect that could lead to issues with self-esteem and self-confidence.

Associated Difficulties Caused by his Jaw Asymmetry

He has also faced speech and eating difficulties throughout his life. Of note, his brother also has a large lower jaw. He had presented to a surgeon in his hometown. Realizing that this was a complicated presentation, he was referred to us for surgery for jaw and chin correction.

The mechanism behind Perception of Jaw Size Discrepancy

The disparity in jaw size is a common cause of facial deformity and asymmetry. Either the lower jaw or the upper jaw can be larger than the other jaw. This could be a result of either a large jaw or a small jaw. A small upper jaw could make a normal lower jaw appear large.

Correction of this deformity could either be through jaw reduction or jaw augmentation. Le Fort I maxillary setback reduces the size of a large upper jaw. Bilateral sagittal split osteotomy reduces the size of a large lower jaw. An increase in the size of the lower jaw is through distraction osteogenesis.

Le Fort I osteotomy is the technique of choice for upper jaw advancement. Jaw reconstructive surgery helps correct a variety of deformities, both congenital and acquired. Facial plastic surgeons also perform these surgeries in Japan and other developed countries.

Initial Presentation for Jaw Correction Surgery at our Hospital

Dr. SM Balaji, facial asymmetry surgery specialist, examined the patient. The patient had mandibular prognathism as well as lower facial asymmetry. Treatment planning was formulated and explained to the patient. He was in agreement and consented to jaw reduction surgery.

Specialty Surgical Procedures Performed at our Hospital

Our hospital is a specialty center for facial cosmetic surgery. Facial plastic surgery in our hospital has transformed many lives. Scar revision surgery for burn scars is performed through tissue expansion. We are a specialty center for cosmetic nose surgery in India.

Successful Surgical Correction of Jaw Deformity

Bilateral bone cuts were first made in the mandible. The nerve was safely mobilized with the distal segment. This allowed for free manipulation of the proximal segment. Extreme care was taken to preserve the inferior alveolar nerve during surgery.

A slice of bone 14mm in thickness was removed from the left side. This was followed by a smaller slice of 12 mm being removed from the right to set right the asymmetry.

Occlusion was checked and was found to be normal. The mandible was then stabilized with plates and screws. His facial appearance was transformed following the surgery. He was very happy with the results of the surgery.

His family thanked the surgical team before discharge from the hospital.

5 Points on Facial Asymmetry Surgery – Facial Cosmetic Surgery

A Minor Degree of Facial Asymmetry is Completely Normal

Both sides of the face are near mirror images though it is never a perfect match. There is a minor degree of facial asymmetry even in normal faces. This is how nature works. There is never perfect symmetry of the face or the body. It is this minor asymmetry that adds to the attractiveness of the individual. This asymmetry is however not evident to common people.

Purely Cosmetic Deformity Versus Function Affecting Deformity

It is only when this degree of asymmetry is present to a degree where it is clearly noticeable that it becomes a problem that needs to be addressed. There are two components to the problems caused by this. One is pure cosmetic where it is only the appearance that is affected and not the function. The second is when normal function is affected by the asymmetry.

Procedures for Cosmetic Facial Asymmetry Correction

Procedures like cosmetic rhinoplasty help correct minor imperfections in the face and enhance the appearance of the individual. Many high visibility celebrities undergo such procedures to enhance their facial features for greater career opportunities.

Facial asymmetry normally manifests itself early in life whether it is idiopathic or caused by a medical condition like hemifacial microsomia. Injuries or infections to the developing baby during pregnancy can also result in facial disfigurement.

It can however occur at any stage in life too as a result of trauma or diseases like cancer. Facial asymmetry is very distressing to the affected individual and leads to associated psychological effects like depression and becoming introverted with self-isolation.

Struggles of Mankind through the Ages for Restoring Normal Facial Appearance

Mankind has tried to address this over the ages through various means. For example, World War I was the first truly global war that led to unprecedented levels of facial mutilation. A special unit was created to help individuals who suffered from facial asymmetry due to injuries sustained in war. Facial Plastic Surgery developed rapidly through the efforts of such units.

The Development of Modern Surgical Techniques

Modern surgery has come a long way in addressing the issue of facial asymmetry. Oral and Maxillofacial Surgery as well as Craniofacial Surgery deal extensively with the correction of facial asymmetry and restoration of normal facial features. An example is the treatment of burns scars. Facial scar revision surgery cost depends upon the extent of scarring.

Surgical techniques such as distraction osteogenesis, bone grafting, sagittal split osteotomy, utilization of biocompatible implants and soft tissue remodeling help restore normalcy in the lives of those afflicted with facial asymmetry.

The cost of facial asymmetry correction surgery varies a lot depending upon the severity of the presentation. It can cost anywhere from INR 1-2 lakhs for minor procedures to INR 3-4 lakhs for major facial deformity corrections.

 

Video [Facial Asymmetry Surgery]

OPEN VS CLOSED RHINOPLASTY WHICH TECHNIQUE IS BEST?

OPEN VS CLOSED RHINOPLASTY WHICH TECHNIQUE IS BEST?

OPEN VS CLOSED RHINOPLASTY : WHICH  TECHNIQUE IS BEST?

RHINOPLASTY AS A LIFESTYLE CHOICE TO ENHANCE QUALITY OF LIFE

Open vs Closed Rhinoplasty: Undergoing a nose correction surgery or a nose job is often a life-changing experience for an individual. A rhinoplasty can change a person’s life for the better or the worse. Many show-biz celebrities from around the world have seen their careers soar or collapse as a result of a rhinoplasty.

NEED FOR EXTENSIVE PRESURGICAL COUNSELING REGARDING EXPECTATIONS

Individuals who present for a cosmetic rhinoplasty have certain expectations about the results. It is imperative that they discuss these expectations in detail with the surgeon during the treatment planning phase itself.

TYPES OF RHINOPLASTY FOR NASAL DEFORMITY CORRECTION

There are two types of rhinoplasty procedures, namely open rhinoplasty and closed rhinoplasty. Open rhinoplasty involves making an incision in the soft tissue between the two nostrils. This allows for easy access to the bony and the cartilaginous parts of the nose. Closed rhinoplasty involves making incisions inside the nose.

INDICATIONS FOR CLOSED AND OPEN RHINOPLASTY

Extreme deformities of the nose are addressed through open rhinoplasty. An open rhinoplasty allows for greater manipulation of the structures that give form to the nose. Lesser deformities of the nose are addressed through closed rhinoplasty. There is minor visible scarring from an open rhinoplasty.  There is no scar formation in a closed rhinoplasty as all incisions are made inside the nose.

The recovery period is longer in open rhinoplasty with more postoperative swelling when compared to closed rhinoplasty. This is due to the greater degree of corrections performed through open rhinoplasty.

IMPORTANCE OF EXPERIENCE OF SURGEON IN COSMETIC NOSE SURGERY

Certain cases that have a complicated presentation can be addressed only through open rhinoplasty. Closed rhinoplasty cannot be performed for the correction of deformities in these cases; however, a vast majority of nasal deformities can be set right through closed rhinoplasty. Surgeons with greater experience can correct even large deformities through a closed rhinoplasty while these corrections are approached through an open rhinoplasty by lesser experienced surgeons.

The average cost for open rhinoplasty is Rs 2,00, 000 and the average cost for closed rhinoplasty is Rs 1,50, 000.

Closed Rhinoplasty with Nasal Augmentation – Cleft Lip Deformity

Patient born with a unilateral cleft lip and palate deformity

The patient is a 20-year-old female from Palakkad in Kerala, India. She had been born with a right-sided cleft lip and palate deformity. Her parents had been extensively counseled on the management of an infant with a cleft deformity. They had been referred to a nearby city for surgical management of her cleft deformity.

She had subsequently undergone cleft lip repair at 3 months of age and cleft palate repair at 11 months. A plastic surgeon had performed these surgeries. The patient had subsequently developed speech difficulties for which she had undergone pharyngoplasty. Bone graft surgery is needed if there is a large cleft alveolus deformity.

Worsening nasal defects with the passage of time

As the patient grew up, her nasal deformities worsened. She had a nose that was flattened and asymmetrical. This was a direct result of the collapse of her columella. Her right alar region was also depressed due to a bony defect. Cleft nasal deformities involve both bone and cartilage. They are the most common form of birth defects.

There was prominent scarring from the cleft lip repair surgery. The patient felt that this detracted from her facial esthetics. It was explained to her that a scar revision surgery can be scheduled at a later date to address that.

Surgery for correcting her nasal deformities done elsewhere

The patient had first undergone cosmetic rhinoplasty (nose job) at the age of 14. This was to correct her severely depressed nose, which was also asymmetrical. Multiple cartilage grafts had been harvested and used in this corrective surgery. She had however not been happy with the end results of the surgery.

A couple of years later, she had undergone a redo rhinoplasty at a different hospital. The old grafts had been removed and replaced with new grafts. This had however worsened the appearance of her nose. She does not require open rhinoplasty.

Her nasal deviation had become worse and she developed a whistling sound while breathing. Her alar base depression had not been addressed by either surgery.

The patient feeling despondent and depressed as a result of the two failed surgeries

Feeling extremely upset by the turn of events, she had slowly become depressed and withdrawn. Her academic performance had also become affected by this. Always a good student, she had become indifferent towards her studies. Alarmed by this, her parents decided to get this addressed to the patient’s satisfaction.

Her parents made widespread enquiries and visited a score of surgical centers over the ensuing months. They got in touch with our hospital manager and sent the patient’s photographs for analysis. Convinced that our hospital was the ideal place for this surgery, they decided to come for a consultation.

Premier center for cosmetic rhinoplasty and cleft rhinoplasty correction

We have been addressing patients with nasal deformities for three decades now. Every variety of nasal deformity correction is performed at our hospital. Our hospital is world renowned for cleft rhinoplasty correction.

We have won accolades from the International Cleft Lip and Palate Foundation of Japan. The World Craniofacial Foundation of USA has made us its Southeast Asian regional affiliate.

Initial presentation at our hospital for detailed consultation and treatment planning

Dr. SM Balaji, nasal cosmetic surgeon, examined the patient and obtained a detailed history and imaging studies. The patient-related her dissatisfaction with the results of the two previous surgeries. She had a severely depressed nose that was asymmetrical. There was resorption of the grafts that had been previously placed for nasal augmentation.

The patient’s nose also had extensive transcolummelar intranasal scar formation from the two previous surgeries. Her columella was also buckled with the resultant flat nose deformity. The patient also related her breathing difficulties with the associated whistling sound.

Treatment planning explained to the patient and her parents in detail

It was explained that costochondral grafts needed to be harvested to aid in the correction of her nasal deformities. The depressed alar base needed to be raised by the placement of a graft in the alveolar cleft. A transcartilaginous incision would next be performed for excision of scar tissue. This would be followed by the placement of a graft to raise the bridge of her nose.

The patient and her parents expressed understanding of the treatment plan and consented to surgery.

Successful surgical correction of her nasal deformities using bone grafts

Under general anesthesia, bone grafts were first harvested from the patient. This was followed by a Valsalva maneuver to ensure that there was no perforation into the thoracic cavity. The incision was then closed in several layers using sutures.

Attention was then turned towards raising the depressed alar base. A graft was placed in the cleft alveolus deformity and fixed using titanium screws. The columella was also raised during this portion of the procedure. This resulted in the correction of her depressed alar base deformity.

A transcartilaginous incision was made followed by excision of previous scar tissue. A bone graft was then introduced to give her nose a pleasing straight profile. Her nasal tip was also sharper. All incisions were then closed with sutures.

Total satisfaction with the results of the surgery

The patient and her parents were extremely happy with the results of her surgery. Her breathing was greatly improved

Surgery Video

 

We are dedicated to giving each of our patients the healthy smile they deserve!