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Ala of nose reconstruction using forehead flap

1/6/2016

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A young man reported to our hospital seeking the expertise of Maxillofacial Surgeon Dr. S.M. Balaji for the cosmetic correction for his nose defect. He had met with an accident and he had a defect in the left nostril (loss of tissue). It was decided to do a nose reconstruction using forehead flap. The advantages of a forehead flap is that the skin color closely matches that of the nose and the harvest site is very close to the surgery site.
Alar base reconstruction was done using forehead flap. Step one was done where the forehead pedicle flap was rotated and attached to the existing ala maintaining good blood supply and following 21 days, second step of flap division was done where exact shape and size of left ala was created without any visible scar and skin discoloration.
Preoperative view
Preoperative worm's eye view
Forehead flap design
Forehead flap pivoted
Stage 2 preoperative state
Adequately formed pedicle
Division of the pedicle
Suturing done after division
Postoperative view after suture removal
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Augmentation rhinoplasty for cleft nose correction

21/7/2014

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A 16-year-old girl from Chennai was brought to our hospital by her parents for expert correction of her cleft nose & lip defect to enhance her appearance. Her nose was flattened and collapsed on the left side and there was an unsightly scar on the lip which affected her appearance. She was previously operated elsewhere for her unilateral cleft lip and palate in her childhood.

Maxillofacial Surgeon Dr. S.M. Balaji successfully performed the cleft rhinoplasty & cleft lip revision. A costochondral rib graft was harvested and used to augment the dorsum of the nose. The collapsed left nostril was reconstructed with a strut graft. The surgery was done from inside the nose so there were no scars. Lip revision was also done simultaneously. Immediately following surgery, the girl’s appearance improved greatly and she was very happy with the surgery outcome.
Preoperative view showing defective cleft nose on the left side with unsightly scar on the lip due to previous surgery
Preoperative view showing depressed left side nostril with illdefined ala of the nose on the left side due to cleft defect
Harvested costochondral graft to augment the dorsum of the nose and shape of the nostrils
Immediate postoperative view showing enhanced dorsum of the nose with symmetrical appearance without any scars
Postoperative view showing reconstructed shape of the nostrils along with lip revision giving prisitne appearance
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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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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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Large nose reduction and alar base correction with immediate results

4/4/2014

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A 25 year old man reported to our hospital wanting to correct his deviated abnormally large sized nose. Because of his appearance of the nose, he was very depressed and he wanted to make his nose pristine without any scars.

Maxillofacial surgeon Dr. S. M. Balaji skillfully planned to correct the nose by following reduction rhinoplasty technique and alar base shaped by using weir excision. Bilateral incisions are made inside the nose and connected by transfixation intercision. Deviated nasal septum was exposed and dissected in such a way that the anterior part was excised in a triangular manner. Both lower lateral cartilages (cephalic portion- foot plate of medial crus) were excised and removed leaving the caudal portion intact.

Both side upper nasal cartilages were divided in the midline through a cut made in the superior part of upper cartilage of the septum (medial osteotomy). Dorsum of the nasal bone was osteotomized by lateral osteotomy technique and rough surface of the nasal bone was smoothened with the rasp. Weir excision was made to shape the ala of the nose. And the flaps were approximated in layers. Results are immediate. The surgery was done within the nose resulting scar less appearance and the nose was shaped to normal size and shape which well blended to his facial appearance and also enhanced the profile of the face.
Pre operative view showing severely deviated bulkier nose
Pre operative view showing severely deviated bulkier nose towards his left side
Profile view showing bulkier with deeply curved and elongated dorsum of nose - parrot beak appearence
During procedure - removal of foot plate of medial crus - right side
During procedure - removal of foot plate of medial crus - left side
Medial osteotomy done to reduce the lenght of the nose
Lateral osteotomy done to reduce the width of the nose
Weir excision done to correct the shape of alar base of the nose - left side
Weir excision done to correct the shape of alar base of the nose - right side
After procedure - immediate post operative view showing well blended alignment of nose towards midline of the face
Post operative lateral view showing enhanced apperanace of nose with scar less appearence
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Dorsal Augmentation with Alar base correction- Nose Job

3/4/2014

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A 28 year old male reported to our hospital with the complaint of deviated nose with depressed nasal bridge and left nostril. His nose was flattened with the ala in the varying level in both sides.

Maxillofacial Surgeon Dr. S.M. Balaji corrected his nose by following Augmentation Rhinoplasty technique with Alar base correction. Cartilage graft has been harvested and sculpted for the correction of depressed nasal bridge. The nasal septum and foot plate of medial crus is removed surgically from the left side along with the correction of alar base. The surgery was done within the nose so there are no scars on the face. Results are immediate and he is happy to have a renewed confidence to have a pristine nose with a new, improved look. 

Preoperative image showing deviated nose with depressed nasal bridge and left nostril
Pre operative view showing asymmetrical nostrils due to defective alar base
Pre operative profile view showing sunken dorsum of nose
Harvested rib graft for the dorsal augmentation and note the depressed nasal bridge before augmetntation
Surgical removal of the nasal septum from the right side
Surgical correction of wide alar base on both sides
Immediate post opeartive showing enhanced dorsum of nose with symmetrically leveled alar base
Basal view showing corrected alar base
Post operative profile showing augmented dorsum of nose
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Augmentation rhinoplasty for enhanced appearance

8/3/2014

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A 35-year-old woman reported to our hospital seeking to enhance the appearance of her nose. Her nose was flattened and ill-defined making her very self-conscious about her appearance. She wanted to improve her facial profile.

Maxillofacial Surgeon Dr. S.M. Balaji performed a nose correction procedure called Augmentation Rhinoplasty. The nasal bridge was raised with a cartilage graft (costal cartilage). The surgery was done within the nose so there are no scars on the face. The woman’s nose was made sharp & pristine that greatly enhanced her appearance & profile. She was very happy to have a renewed confidence with a new, improved look.
Flattened, ill-defined nose
Profile view before surgery
Surgical planning with costal cartilage
Nose made sharp & pristine without scars following augmentation rhinoplasty
Enhanced appearance in profile view following nose correction
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