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1. Rhinoplasty in India
Dr.K.O.Paulose FRCS DLO
Consultant ENT Surgeon
Jubilee Hospital, Trivandrum, Kerala, India.
www.drpaulose.com

2. www.drpaulose.com

3. Rhinoplasty in Jubilee Hospital

4. The procedure

5. Types of Rhinoplasty
 Rhinoplasty can be
done by the Open
(External) or
closed (Internal)
technique. This will
depend on where
the incisions are
made.
 Reduction and
Augmentation

6. Open:External Rhinoplasty

7. Introduction
 Rhino (Latin for nose)
and plasty (Greek for
molding or forming)
 Greek word plastikos
meaning to give
something shape or form.
 Rhinoplasty is a surgical
procedure used to modify
the size and shape of the
nose in order to give it a
more pleasant look.
Harmonize your nose and
show off a really
proportionate face.

8. Rhinoplasty in Ancient India
 Noses were symbols of pride
 Tempting targets during warfare.
 Amputation of the nose -offenses,
including adultery.
 Sushrutha, (600 B.C.)
 ‘Sushrutha Samhitha‘-surgery in
detail

9. Sushrutha:Rhinoplasty

10. Rhinoplasty Anatomy

11. Nasal anatomy

12. Rhinoplasty Anatomy

13. Columella Incision

14. External Rhinoplasty Procedure

15. External Rhinoplasty:Osteotomy

16. Surgeons at work

17. Surgeons at work

18. Local or GA
 if your nose only
needs a little
reshaping, you can
probably have local
anesthesia. If you
need more
extensive work,
you will probably
need general
anesthesia.

19. Post op period
 Recovery may not be comfortable.
 Pain
 Bruising-swelling-edema
 Black eye
 Nasal blockage
 Blood stained nasal discharge

20. Complications
 Infection-Signs of an infection
include redness, severe swelling,
discharge, a foul smell, severe pain
or a fever over 100.5º F.
 Bleeding ,hematoma ,seroma .
 Numbness
 Anosmia-temporary
 General Dissatisfaction

21. External Rhinoplasty Procedure

22. Rhinoplasty:Reduction

23. Rhinoplasty preoperative
aesthetic evaluation
 The goals of aesthetic surgery are a
satisfied patient and surgeon
 Occasionally, the patient suffers from
a psychiatric illness.
 understand the motivation of the
patient
 Digital images of nose and face
 Step ladder principle

24. Step ladder principle
 One cannot climb
more than one or
two steps in a
ladder
 Ugly nose can be
made better nose
 Normal nose can be
made pretty nose
 Ugly nose cannot be
made pretty Nose

25. Nose sculpturing:Types
 Techniques
 Closed and open Rhinoplasty
 Open Rhinoplasty better
 Dorsal hump reduction
 Shortening of lower lateral cartilage
 Sculpture of nasal tip

26. Septoplasty with Rhinoplasty
 Septal Correction
Always done if
needed
 Septoplasty
corrects the
functional issues of
nasal airway

27. Septoplasty pre and post op

28. Septoplasty

29. Removing Maxillary Crest

30. Rhinoplasty Under GA

31. Tip Sculpturing
 Making the tip
shorter
 Done by External
Rhinoplasty
 See pre and post
op pictures

32. Iliac crest and conchal graft

33. Final Suturing and packing
 Suturing by5x0 Ethilon and
3x0 catgut
 Nasal Packing: Merocel –
Compressed gel-for
internal nasal pack.
 Internal Silastic Splint-
This keeps the septum in
place, and removed after
5-7 days time.
 External Thermpolastic
Splint. It will be removed
in 7 days time.

34. Final suturing and packing

35. Surgery over

36. Post op recovery

37. Post op ward

38. Pre and Post op pictures

39. Pre and post op pictures

40. Pre and Post op picture

41. Pre and Post Op pictures

42. Pre and Post op pictures

43. Unrealistic Expectation
 Selection of patient
 Pre op counseling
 “film star Nose”

44. Pre and post op picture

45. Pre and Post op picture

46. Pre and Post op pictures

47. Pre and Post Op pictures

48. Pre and Post Op pictures

49. Best Candidates for Rhinoplasty
 Those looking for
improvement, not
perfection
 Those that are physically
healthy, psychologically
stable, and have realistic
expectations
 Age -not to operate on
teenagers until after they
have completed their
growth spurt.

50. THANK YOU
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