Long-Term Results Using "Nair Hospital Precision Carving" Technique of Rhinoplasty

Abstract

Background and Objectives Convincing a patient who has undergone any aesthetic surgery to come for a long-term follow-up is extremely difficult. The result obtained after rhinoplasty usually stabilizes in the first year and it is unlikely to change after 2 years. The precision carving technique described in 2014 has been employed by us for the last several years. We wish to present long-term results (at least 2 years) obtained using this technique, now renamed as "Nair Hospital Precision Carving technique." The unfavorable effects of warping are most apparent in the dorsum. So, we have chosen to assess results of dorsal onlay grafts only. This article presents the long-term results obtained using favorable warping technique. Materials and Methods We have followed up 45 patients in whom dorsal augmentation was done using rib grafts for various indications like aesthetic, reconstructive rhinoplasty and cleft lip nasal deformity. Grafts were carved using the precision carving technique. Results All patients were assessed at 6 weeks, 6 months, and at subsequent follow-up period of 2 to 10 years and photographs were taken at each visit. There was no major complication and all patients were satisfied with the appearance. Conclusion The Nair Hospital Precision Carving technique utilizes unbalanced yet controlled and precise carving to achieve a variety of natural shapes for the objectives of contour fill and framework reconstruction in rhinoplasty, thus ensuring good long-term results.

Keywords: aesthetic surgery; contour fill; dorsal onlay graft; framework reconstruction; nair hospital; precision carving technique; rhinoplasty.

Fig. 1

A soap or a clay template is used to estimate the volume of cartilage needed.

Fig. 2

A 28-year-old with septal collapse underwent a septal reconstruction and an onlay graft for projection. The result is maintained even after 10 years. The signs of aging on his face can be made out, but the nasal configuration, projection, and proportions are maintained.

Fig. 3

A 25-year-old with defect of lobule, columella, and membranous septum. Costal cartilage carved for onlay graft, alar cartilages, and columellar strut. The recreated defect with restored cartilage framework in place and a paramedian forehead flap has been transferred to cover the framework. The result seen at 6 years after surgery is aesthetically pleasing.

Fig. 4

A 26-year-old with cleft lip nasal deformity desirous of better looking nose underwent correction and augmentation using onlay graft carved with the Nair Hospital Precision Carving technique. Maneuvers included osteotomies, septoplasty, columella lengthening, and maxillary augmentation. The result at 3 years postsurgery looks natural, with hardly any stigma of cleft nasal deformity.

Fig. 5

Forehead flap was used to cover the reconstructed ala lateral wall ala and dorsum. Result at 2 years shows minimal warping, but overall aesthetics and proportions have been restored.

Fig. 6

A 28 years old male had reduced projection of dorsum and increased width of the bridge. He was operated for cosmetic correction ( Fig. 6 ) and we used the costal cartilage graft to improve the dorsal projection and restore the dorsal aesthetic lines. Osteotomy helped to reduce the width of the nose. The aesthetic result achieved and the projection gained is maintained at the 3-year follow-up.