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Flattened nose correction without any scars

30/5/2014

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A 30 year old man reported to our hospital wanting to correct his nose profile which was very broad and flat to his face. He also wanted to correct his nose tip which was ill-defined that gave him more aged appearance. Due to his defective nose profile he was very self conscious about his appearance.

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his nose by following Augmentation Rhinoplasty technique with alar base correction. Costochondral graft was harvested from the ribs, shaped and used to reconstruct the nose to increase the height. Thus proper shape of the nose was achieved. Alar base was corrected with Weir excision and the nostrils were made defined and symmetrical. Entire nose correction was made within the nose (closed rhinoplasty technique); there are no scars on the face. Results are immediate and the patient was very happy to see his enhanced profile of the nose without any scars. This dramatically improved his appearance and self confidence. 

Pre operative view showing broad and flat nose with illdefined columella of the nose
Pre operative profile view showing flat dorsum of the nose with deep curve in the base of the nose
During procedure costochondral graft harvested to augment the dorsum of the nose
Immediate post operative view showing defined columella with alar base refined by Weir excision
Post operative profile view showing augmented dorsum of the nose with correction of the base of the nose
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Successful closure of alveolar cleft defect with rhBMP-2

29/5/2014

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A 6 year old boy with bilateral cleft lip and palate was brought to our hospital with the complaints of escape of food and water to the nose while eating and slurred speech due to escape of  air to the nose through the hole in the teeth bearing region of the upper jaw. Primary cleft lip and palate repair was done elsewhere.

After thorough clinical and radiographic examination Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that in the previous cleft surgery the Surgeon has removed the premaxilla completely along with the developing tooth buds. Thus a part of alveolus along with the few teeth was missing which led to huge cleft defect in the midline of the upper jaw bone.  Dr. Balaji skillfully planned to close the cleft alveolar defect with the miracle protein rhBMP-2.

A gingivomucoperiosteal flap was raised and the cleft defect was exposed and miracle protein rhBMP-2 was placed in the alveolar cleft defect region and the flap was approximated with sutures. This protein helps the body’s own cells to form new bone at the site of placement. After 3 months achieving complete union of the segmented alveolar bone into a single complete maxilla, replacement of missing teeth followed by orthodontic treatment will be planned. 
Pre operative intra oral view showing missing teeth in the upper anterior region due to cleft alveolar defect
During procedure, huge alveolar cleft defect exposed due to missing premaxillary segment
Miracle protein rhBMP-2 placed in the alveolar cleft defect to induce own body cells into bone forming cells
Water tight closure of the gingivomucoperiosteal flap
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Successful correction of protruding lower jaw without any scars

27/5/2014

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A 25 year old man reported to our hospital seeking to correct his protruding lower jaw. This gave him an aged appearance and he was not happy with his facial profile.

Maxillofacial Surgeon Dr. S. M. Balaji expertly planned to correct his lower jaw protrusion by using bilateral sagittal split osteotomy technique (Obwegeser sagittal Split osteotomy). Intraorally a cut was made bilaterally in the lower jaw bone in the mandibular ramus region and the bone was set back to its correct position and thus correct dental occlusion was achieved. Results are immediate and the patient was happy to have his jaw bone correction done without any scars on the face. His profile also improved dramatically giving him a renewed confidence.
Pre operative profile view showing severely protruded lower jaw
Pre operative intra oral view showing reverse bite - negative overjet
During procedure - sagittal split osteotomy on the right side of lower jaw
During procedure - sagittal split osteotomy on the left side of lower jaw
Post operative profile view showing enhanced appearance without any scars
Post operative intra oral view showing corrected bite with excellent overjet achieved
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Successful closure of alveolar cleft defect with iliac bone graft

24/5/2014

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A 13 year old girl was brought to our hospital by her parent’s wanting to treat her alveolar cleft defect. There was a huge oronasal communication causing a depressed nose. She was born with unilateral cleft lip and palate and was operated elsewhere in her childhood.

Maxillofacial Surgeon Dr. S. M. Balaji skillfully performed the cleft alveolar correction surgery with iliac bone graft on the parent’s request. An incision was made on the iliac crest and using the “Trap door technique” cortico-cancellous bone graft was harvested. A block of medial cortex of the iliac bone was harvested. The donor site was closed in layers.

Intraorally, a gingivomucoperiosteal flap was raised to expose the alveolar cleft defect. Since there was a huge oronasal communication causing nasal depression, the bone graft was used to reconstruct the alveolar base. The graft was fixed with a titanium screw to completely close the communication and to raise the alar base. Results were immediate. The patient and her parents were very happy to have the huge cleft defect successfully treated without scarring. 
Alveolar cleft defect with huge oronasal communication
Iliac bone harvested using trap door technique
Donor site was sutured in layers resulting in very minimal scarring
Intraorally gingivomucoperiostael flap raised and huge oronasal communication due to cleft defect was exposed
Harvested bone graft was fixed to the alveolar base with a titanium screw to completely seal the cleft defect
Water tight closure of the gingivomucperiosteal flap
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Surgical correction of shape of the nostrils without any scars

23/5/2014

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A 25 year old man reported to our hospital with the complaint of bulge in the left side of the nostrils. He was depressed due to the asymmetry of the nostrils which affects his self-confidence considerably. He was very particular to have the correction done without any scars.

Maxillofacial Surgeon Dr. S. M. Balaji diagnosed that because of the deviated anterocaudal portion of nasal septal cartilage towards left side and footplate of medial crus was also excessively curved, the nostrils were asymmetrical.      Dr. Balaji expertly planned to correct his shape of the nostrils intra nasally. Surgically the excessively curved nasal septal cartilage and foot plate of medial crus were removed. Thus surgery was done within the nose so there are no scars on the face. Results are immediate and the patient was also happy to have his nose corrected and made pristine to his face without any scars. 
Pre operative view showing excessively curved anterocaudal portion of nasal septal cartilage
Intranasally severely curved nasal septal cartilage with footplate of medial crus was exposed
Severely curved antero caudal portion of nasal septal cartilage was excised completely
Immediate post operative view showing enhanced symmetrical appearance of the nose without any scars
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Successful pharyngoplasty surgery for correction of velopharyngeal incompetence (nasal-twang speech)

22/5/2014

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An 18-year-old boy reported to our hospital seeking expert treatment of his speech defect due to cleft birth deformity. He was born with unilateral cleft lip and palate for which he was operated upon in his childhood elsewhere.

Now he complained of nasal twang in his voice. This is due to velopharyngeal muscle incompetence which causes escape of air through the nose during speech. Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the pharyngoplasty surgery rearranging the pharyngeal muscles in correct position to create a dynamic sphincter. Suction test was positive indicating successful correction of velopharyngeal incompetence.  

Pre operative intra oral view showing defective soft palate muscle attachments causing VPI
Surgical view showing Pharyngeal muscle detachment on the right side
Pharyngeal muscles detached from the incorrect position on left side
Immediate post operative view showing corrected soft palate muscular attachments achieving dynamic sphincter
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Reduction Rhinoplasty for bulky nose without scars

21/5/2014

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A 21-year-old man reported to our hospital seeking to correct his large, bulky nose which greatly affected his facial appearance. He was very much disappointed as his nose profile was disproportionately bigger due to the huge dorsal hump of his nose.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the reduction rhinoplasty technique. Vertically nasal septal cartilage height was trimmed and dorsal bony hump reduction was done by medial osteotomy to reduce the height of the nose. Width of the nose was also reduced by lateral osteotomy technique. Resection of cartilaginous and bony hump was done with wide chisel. Thus bulky nose and size of the framework of the nose was reduced from inside the nose to avoid any scars on the face (closed rhinoplasty technique).

A balance between the nose shape and facial profile was achieved for a more pleasing appearance. The patient was very happy to have a narrower, shapely nose that enhanced his facial profile with absolutely no scarring. 
Pre operative profile view showing large nose with huge dorsal hump
Pre operative view showing bulky nose tip
Vertically nasal septal cartilage height was trimmed surgically
Medial osteotomy done to reduce the dorsal hump of the nose
Post operative profile view showing enhanced appearance of the nose
Post operative view shows bulky nose tip reduction without any scars
Comments

Broad flattened nose correction without any scars

20/5/2014

Comments

 
A 25 year old man reported to our hospital with the complaints of broad and flattened nose which gave him an aged appearance. He was not happy with his nose profile.

Maxillofacial Surgeon Dr. S. M. Balaji skillfully planned to correct his nose following Augmentation Rhinoplasty technique with alar base correction. Rib cartilage graft has been harvested and shaped to correct dorsum of the nose.  Alar base was corrected by Weir excision technique. Thus surgery was done within the nose (closed rhinoplasty technique); there are no scars on the face. Results are immediate and the patient was very happy to see his enhanced appearance of his nose without any scars. This dramatically improved his profile and renewed his confidence.
Pre operative profile view showing depressed bridge of the nose - saddle nose appearance
Pre operative view showing indistinct columella of nose giving flat and broad appearance
Rib cartilage graft harvested to reconstruct the bridge of the nose
Harvested rib cartilage graft shaped to reconstruct the framework of the nose
Immediate post operative profile view showing enhanced appearance of dorsum of the nose without any scars
Immediately after surgery columella of the nose raised and shape of the alar base corrected by Weir excision
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Successful isolated cleft palate repair surgery

19/5/2014

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Pre operative intra oral view showing isolated cleft palate
Immediate post operative intra oral view showing complete closure of the palatal cleft using palatal push back technique
A 1.5 year old boy with isolated cleft palate was brought to our hospital for the surgical closure of the gap (cleft) in the roof of the mouth (palate). The boy’s cleft palate defect was classified as Millard’s 10 and 11.

Maxillofacial Surgeon Dr. S. M. Balaji surgically corrected the cleft palate using palatal pushback technique. Incision was made in the mid- vomerine region. The palatal flap was raised on both right and left side. The Levator palatine muscle was detached from their abnormal positions and reattached to its normal position like a hammock. A two layer closure was done. The nasal floor was closed with the vomerine flap making a reverse knot. Oral layer was sutured by vertical mattress sutures. Results are immediate and the suction test was positive which ensures improved speech. 
Suction test positive guarentees improved speech
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Saddle-nose Rhinoplasty without scars

18/5/2014

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A 25-year-old girl reported to our hospital seeking to correct her nose defect to enhance her appearance. The middle portion of her nose appeared collapsed and depressed giving the nose an unattractive, concave, “saddle-like” appearance.

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the rhinoplasty to correct the nose defect. A costochondral graft was harvested and used to reconstruct the collapsed dorsum of the nose. An intranasal approach was used to avoid scarring on the face. Immediately after surgery, the contour of the nose improved greatly. The nose was made sharp and pristine. Facial appearance improved distinctly and the girl was very happy to have a more attractive facial profile without any scars. 

Depressed nose affecting facial appearance
Saddle-nose defect causing an unattractive appearance
Costochondral graft harvested to reconstruct the collapsed dorsum of the nose
Immediately after rhinoplasty-nose made sharp and pristine without scars
Appearance enhanced after nose correction without any scars
Comments

Complete closure of alveolar cleft using miracle protein rhBMP-2 avoiding bone grafting

16/5/2014

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A 3-year-old girl born with bilateral cleft lip and palate reported to our hospital seeking specialized treatment for her cleft defect in the alveolar bone (teeth bearing region of upper jaw). She was previously operated for cleft lip & cleft palate.

Due to the bilateral cleft, her maxilla or upper jaw bone was in 3 parts. Maxillofacial Surgeon Dr. S.M. Balaji performed the alveolar cleft reconstruction using the miracle protein rhBMP-2. This protein stimulates the body’s own cells to rapidly form new bone at the site of placement. Following surgery, there was complete bone fill in the cleft defects thereby joining the 3 segments into a single complete maxilla.

By using this revolutionary technology, additional bone graft surgery and scarring at the graft site is avoided. Dr. Balaji has successfully used this novel protein in complete reconstruction of several facial bone defects.

Alveolar cleft defect in child with bilateral cleft lip & palate
Alveolar cleft defect causing the maxilla to be in 3 parts
During surgery- cleft site exposed
rhBMP-2 placed in the cleft site
rhBMP-2 will stimulate new bone formation to heal bone defect
Reconstruction of alveolar cleft using rhBMP-2 avoiding bone grafting
Successful healing of cleft defect reconstructing the maxilla into one complete bone few months after BMP surgery
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Cleft rhinoplasty without scars

9/5/2014

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Cleft nose defect before rhinoplasty
Right side of the nose collapsed due to the cleft defect
Costochondral graft harvested
Graft used to reconstruct the nose from inside the nose itself to prevent scar
Immediately after rhinoplasty- nose made sharp and defined without scar to enhance appearance
Immediately after rhinoplasty- nose defect successfully reconstructed without scars
A 30-year-old man reported to our hospital seeking specialized treatment to correct his cleft nose defect. He was previously operated for cleft lip and palate elsewhere in his childhood. Due to the cleft defect his nose was collapsed on the right side and it affected his facial appearance.

Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the rhinoplasty or nose correction. A cosochondral graft (rib graft) was harvested and used to reconstruct the collapsed nasal framework. The surgery was approached from inside the nose so there was no scar. Immediately after surgery, the nose appeared sharp and defined giving a more pleasing appearance. The patient was very happy to have his nose defect corrected without any scars.  
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Combined rhinoplasty and lower jaw correction without scars

8/5/2014

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Cleft nose defect affecting facial profile
Nose defect and protruding lower jaw causing an unpleasant appearance
Costochondral graft harvested to reconstruct the nose
Immediately after rhinoplasty- nose reconstructed without scars
Nose defect corrected & protruding lower jaw set back with corrective jaw surgery without scars
A 26-year-old girl reported to our hospital seeking expert correction of her cleft nose and jaw defect to enhance her facial profile. She was operated elsewhere in her childhood for cleft lip and cleft palate. Now her nose appeared collapsed on the left side and her protruding lower jaw deflected from a pleasing profile. 

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed a combined nose & jaw correction. A costochondral graft was harvested and used to reconstruct the collapsed portion of the nose. The procedure was done from inside the nose itself so that there are no scars. Mandibular shortening was done to make the lower jaw proportionate and to improve the facial profile. Immediately following surgery, her facial profile and appearance greatly improved and she was very happy to have a more attractive appearance without any scarring on the face. 
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Rhinoplasty for correction of flattened nose without scars

6/5/2014

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Broad, flattened nose causing unpleasant appearance
Costochondral graft harvested
Nose reconstructed using graft through intranasal approach-nose made sharp & pristine without scars
A 27-year-old girl reported to our hospital seeking expert treatment for her flattened nose. She wanted to improve the appearance of her nose for a more attractive facial profile.

Her nose was board and flat with the middle portion of the nose appearing obscure. Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the rhinoplasty surgery. A costochondral graft was harvested and used to reconstruct the dorsum of the nose. The surgery was approached from inside the nose so there was no scarring on the face. Immediately after surgery, the nose appeared sharp, pristine and overall made the face more attractive. The patient was very happy to enhance her looks without scars. 
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Simultaneous nose and jaw correction for Binder syndrome

5/5/2014

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An 18-year-old girl reported to our hospital seeking expert treatment for her nose and jaw defect. Her flattened nose and disproportionate upper & lower jaw affected her facial profile and she was very unhappy with her appearance.

After thorough radiological investigations, Maxillofacial Surgeon Dr. S.M. Balaji diagnosed the girl to have Binder’s syndrome or maxillo-nasal dysplasia in which the development of the nose and jaw is affected leading to an unusually flat, underdeveloped mid face. Dr. Balaji skillfully performed a combined jaw & nose correction surgery to correct the facial imbalance. 

A costo-chondral graft was harvested and used to reconstruct the nose through an oral vestibular approach. Corrective jaw surgery for the upper and lower jaw was done to make the jaws proportionate and into accurate alignment. Since the procedures were done from inside the mouth, there was absolutely no scarring. With this combined rhinoplasty and jaw correction, the girl’s facial appearance improved dramatically. She was very happy to have a more pleasing appearance and balanced facial features without any scarring.  

Comments

Cleft nose correction without scars

3/5/2014

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Left side of the nose depressed due to cleft defect causing a flattened, unpleasant appearance
Left ala of nose collapsed & depressed
Harvested graft shaped to reconstruct nose framework
Immediately after surgery-nose reconstructed using graft without scars
Immediately after rhinoplasty done from inside the nose to avoids scars
A 22 year-old-girl born with unilateral cleft lip and palate reported to our hospital seeking expert treatment for her cleft nose defect. Due to the cleft, the left side of her nose was deformed which affected her appearance and she wanted to correct her facial profile. 

Maxillofacial Surgeon Dr. S.M. Balaji skillfully performed the cleft rhinoplasty. The left ala of the nose was severely depressed. Costo-chondral cartilage was harvested and shaped to reconstruct the nasal framework. Through an intranasal approach the depressed left ala was lifted up by placing the shaped graft.  The cartilaginous strut graft was positioned between the medial crura to reconstruct the base of the nose. Immediately after the surgery the shape and appearance of the nose improved greatly. Also since the surgery was done from inside the nose, there were no scars. The girl was very happy with her improved appearance & facial profile. 

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Successful rhinoplasty surgery for flattened nose without scars

2/5/2014

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A 13 year old boy reported to our hospital with the complaints of flattened nose profile. The boy and his parents were very unhappy due to the badly flattened nose giving him an unattractive appearance. 

Maxillofacial Surgeon Dr. S. M. Balaji expertly performed the rhinoplasty surgery to correct the profile of the nose using costo chondral graft through intra oral approach. A sulcular incision was placed and through an intraoral approach, the costo chondral graft harvested from the rib was inserted into the nasal septal region and stabilized with the adjacent nasal cartilages. Thus the dorsum of the nose was enhanced with the graft. The nose defect was successfully corrected without any scars and the results were immediate. The boy and his family were very happy with the surgery outcome and the improved facial appearance. 

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