A 26-year-old girl reported to our hospital seeking to correct the appearance of her nose. Her nose was much flat and she wanted to have a sharp nose to improve her appearance.
Maxillofacial surgeon Dr. S. M. Balaji expertly performed the augmentation rhinoplasty. A costochondral cartilage graft was harvested and used to reconstruct the depressed dorsum of the nose. The surgery was done from inside the nose (closed rhinoplasty) so there is no scarring. The patient is very happy to have a sharp, defined & pristine nose immediately after surgery, which improved her appearance. 

A 32 year old woman came to our hospital for expert treatment for her lower jawbone defect. She gave the history of huge odontogenic keratocyst lesion involving left mandibular angle and ramus along with the entire condylar component was removed extraorally and reconstructed using costochondral rib graft elsewhere. But the graft got infected and removed and reconstruction plate was fixed. Later plate was broken and was removed.  Her complaint was jaw deviation towards left side and facial asymmetry. Also she wants to correct her facial appearance without any scars on the face. 

Maxillofacial Surgeon Dr. S.M. Balaji performed the clinical and radiological investigations. OPG and 3D CT scan showed complete absence of left side angle and ramus of mandible with remnants of bone graft. Dr. Balaji successfully reconstructed the huge mandibular defect maintaining the contour using titanium “L” plate and costochondral rib graft and thus missing condylar component was also reconstructed, the surgical site was closed. Patient feels very happy to have entire surgery done inside the mouth and to have complete facial asymmetry correction without any scars on the face.

​A young African boy from Nigeria suffering from Ectodermal Dysplasia was referred to our Hospital for expert care. He had multiple missing teeth & had previously undergone bone grafting elsewhere but the graft had already resorbed & failed.
Maxillofacial Surgeon and Dental Implantologist Prof. Dr. S.M. Balaji performed the complete jaw bone reconstruction using costochondral rib graft . Implants were placed to replace his missing teeth. Following osseointegration of the implants, cosmetically well blended fixed ceramic prosthesis was given enhancing the appearance.

​A 16 -year-old girl reported to our hospital seeking specialized treatment to correct her cleft nose defect. She was previously operated for cleft lip and palate elsewhere. Due to the cleft defect her nose was collapsed on the left side and it affected her facial appearance.
Maxillofacial Surgeon Dr. S.M. Balaji expertly performed the Corrective rhinoplasty or nose correction. A costochondral 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. Secondary lip repair was also done to correct the vermillion defect. Immediately after surgery, the nose appeared sharp and definite giving a more pleasing appearance. The patient was very happy to have her nose defect corrected without any visible surgical marks on the face. 

A 6 year old boy was brought to our hospital with a complaint of decreased mouth opening and facial deformity. No history of trauma elicited by his parents. Extra oral examination revealed severely retruded mandible, flattened lower face and complete restriction in mouth opening.
OPG revealed obliterated right joint space elongated coronoid process, reduced ramal height and prominent antegonial notch. The case was diagnosed as true right TMJ bony ankylosis with developing secondary facial deformity.  
Maxillofacial Surgeon Dr. S. M. Balaji successfully performed gap arthroplasty using temporalis flap interpositioning. Followed by active physiotherapy, mouth opening improved dramatically. But patient failed to be on regular follow up.
After 9 years, exactly at the age of 15, patient reported with the complaint of restricted mouth opening, severe secondary facial deformity and retruded chin giving bird face appearance.
On thorough clinical and radiological examination, it was diagnosed as left TMJ ankylosis with functional right pseudo joint. Dr. S. M. Balaji performed left gap arthroplasty and bilateral condylar component reconstruction using 5th and 7th costochondral rib graft (CCG).
Postoperative mouth opening was adequate. Over 8 years follow up, bilateral CCG was favorable and lower facial projection was improved significantly with increased mouth opening.

Hemifacial microsomia is a condition in which there is an under-development of one side of the face resulting in facial asymmetry. The affected side of the face appears disproportionately smaller than the other. Characteristically, the lower jaw (mandible), facial soft tissues & musculature, cheek and ear on one side of the face is poorly developed. Sometimes, structural defects in the eye may also be seen. A 28-year-old boy afflicted with Hemifacial Microsomia reported to our Hospital. His lower jaw and ear was under-developed on the right side. He had a slanting bite and an obvious asymmetry of the face. A radiographic examination showed a grossly under-developed lower jaw (mandible) on the right side. There was found to be a bone deformity of about 20 mm.
The goal of the treatment is to elongate the deficient jaw bone to restore facial symmetry and correct the slanting bite (occlusion). To achieve this, an advanced and effective treatment technique is distraction osteogenesis. This is a new technique for regenerating new bone by slow, progressive stretching of the bone, without requiring a bone graft.
Eminent Craniofacial Surgeon Dr. S.M. Balaji is a pioneer in introducing this revolutionary technique and has successfully rehabilitated the maximum number of patients afflicted with facial disfigurements in the country.
In distraction osteogenesis, the jaw bone on the deficient side is cut. A sophisticated device called distractor is placed such that the two arms of the device are fixed to the two segments of jaw bone. After a few days, a screw attached to the distractor is turned gradually, ideally at a rate of 1 mm per day. When this is done, the two cut segments move apart and new bone is formed in the resultant gap. After the required length is achieved and new bone is stabilized, the distractor device is removed subsequently correcting the asymmetry of the face.
This is a powerful tissue engineering technique for generating bone for the desired volume. The overlying soft tissues that are deficient also are expanded, therefore along with the underlying bone deformity, the overlying skin and soft tissue defect is also corrected.
This is the only procedure to increase the size of the jaw bones after the cessation of actual bone growth. For this patient, Dr. Balaji adopted a stage-by-stage rehabilitation. To correct the jaw deformity, he applied the innovative simultaneous maxillary and mandibular distraction procedure wherein new bone is formed in both the upper and lower jaws simultaneously to restore facial symmetry.

​A young man came to our hospital seeking corrective jaw surgery to enhance his appearance. His lower jaw was excessively protruding causing an incorrect teeth occlusion that caused difficulties in biting and chewing. Additionally his chin bone was deviated away from the midline giving his face an asymmetric, crooked appearance.
Maxillofacial surgeon Dr. S.M. Balaji planned to correct the jaw defect with a combined bilateral Obwegeser’s sagittal split osteotomy and genioplasty. The mandible was set back to correct the alignment and bite using bilateral Obwegeser’s sagittal split osteotomy. With genioplasty, the deviated chin bone was corrected. The procedure was done from inside the mouth so there were no scars. Immediately after this corrective jaw surgery, the man’s appearance was greatly improved and he is very happy with the enhanced aesthetics.

A 26 year old boy visited our hospital seeking for correction of his facial profile to enhance the appearance. He was under orthodontic treatment for past 2 years elsewhere. But he was not satisfied with the results and thus he wants to have surgical correction of his jaw without any scars on the face.
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After thorough clinical and radiological examination, Maxillofacial Surgeon Dr. S.M.Balaji planned to correct his face by following corrective jaw surgery. He has short upper lip due to vertical maxillary excess which was corrected by Lefort I osteotomy. His profile shows short chin giving round face appearance. This was corrected by augmenting the genium using costochondral rib graft. Thus entire surgery was done inside the mouth and his facial appearance improved dramatically. Patient feels very happy to have the entire facial correction in a single surgery and without any visible surgical marks on the face.

A 3-month-old baby girl born with bilateral cleft lip and palate was brought to our hospital by her parents for specialized cleft lip & palate surgery.
Maxillofacial Surgeon Dr. S.M. Balaji performed the primary cleft lip correction surgery to reconstruct the lip enabling the baby to feed well while also dramatically enhancing the baby’s appearance.  Subsequent cleft palate surgery will be done to completely rehabilitate the child.