Redo Rhinoplasty – Removal of Mobile Silastic Graft

Patient with a history of cleft lip, palate and alveolus surgery

The patient is a 22-year-old female from Kanpur in Uttar Pradesh, India. She was born with a cleft lip and palate deformity. Doctors had counseled her parents about what to expect with cleft children. They had also presented them with a schedule for surgical correction of her deformities.

Past history of surgical correction of her cleft deformities

She had undergone cleft lip surgery at 3 months of age and cleft palate surgery at 8 months old. Cleft alveolus surgery had been performed at 4 years of age. All these surgeries were performed in a neighboring state at the same hospital.

Her parents had been satisfied with the results of the surgery. The hole in the roof of the mouth had been completely closed and the patient had no feeding or speech problems.

However, as the patient grew up, her nasal deformity had gradually worsened. Her nostrils were asymmetrical and she had a collapsed bridge of the nose. She had a saddle nose deformity with gross nasal asymmetry caused by a depressed left nostril. This caused her to become depressed and they decided to get this addressed at a nearby city.

Failed primary rhinoplasty with mobile silastic graft

She underwent a primary rhinoplasty about two years ago for correction of her nasal deformities. This had been performed utilizing a silastic graft to lift up the dorsum of her nose. Nasal tip had also been enhanced by the surgery. All deformities of the nose involve components of bone and cartilage.

The graft however never stabilized and remained mobile. This has made the patient very self conscious and withdrawn. It finally reached the point where she decided to get this addressed.

The patient and her parents made extensive enquiries regarding the best rhinoplasty hospital in India. They were repeatedly informed that we were the best hospital in India or rhinoplasty correction. She discussed this extensively with her parents and they decided to come to our hospital for her surgery. The best rhinoplasty surgeons in India come to our hospital for regular workshops.

India is a top destination for medical tourism from around the world. Nose reshaping through cosmetic surgery is one of the most commonly desired procedures by such patients. The cost in India is also just a fraction of what it costs in the developed countries. Surgical results though are on par with the results obtained in the Western world.

Initial visit for consultation and treatment planning at our hospital

Dr SM Balaji, cosmetic rhinoplasty surgeon, examined the patient and obtained a detailed history from her parents. He also ordered pertinent imaging studies including a 3D CT scan.

The patient said that the graft on her nasal dorsum was mobile. This caused her to become extremely self conscious. She had also begun to withdraw socially because of this.

Examination of her nose revealed an extremely mobile nasal bridge. This was the result of the infected silastic nasal graft. There was a depression of the left side of the nose from the cleft lip deformity. The left nostril was also considerably smaller in size along with a noticeable depression in the left anterior maxillary region.

Rationale behind treatment planning explained to patient and parents

It was explained that the silastic graft needed to be removed.  A costochondral graft would be utilized for nose correction. The grafts would be harvested from the patient at the beginning of the surgery.

Successful surgical correction of maxillary depression and nasal deformity

Under adequate general anesthesia, an incision was made in the right inframammary region. A costochondral rib graft was harvested. Valsalva maneuver was then performed to ensure that there was no perforation into the thoracic cavity. The wound was then closed in layers with sutures.

A transcartilagenous incision was made in the right nostril. This was followed by dissection and removal of the infected silastic graft. The nasal dorsum was then augmented using the costochondral graft along with a strut graft to elevate the left nostril.

Patient expresses happiness at the results of the surgery

The patient was extremely happy with the results of the surgery. Her nose now had a more symmetrical and prominent profile. It was in complete harmony with her face with equal nostril size. She said that this would help her gain more self confidence and participate in social events without feeling self conscious.

Surgery Video