Background:Autogenous costal cartilage is a good option for large volume requirements in rhinoplasty, when septal or conchal cartilages do not suffice. Reluctance to use costal cartilage is due to apprehension of warping. However, warping can be avoided if we follow the principle of balanced section as advocated by Gibson and Davis. “Warping” can also be utilized to change the curvature of the graft.Materials and Methods:We have used 69 costal cartilage grafts as a solid piece for contour fill in rhinoplasty in 31 patients over the last 10 years. Principle of balanced section as advocated by Gibson and Davis was adhered to while carving the grafts, however some grafts were allowed to warp to get different sizes and shapes.Results:All the procedures were uneventful. Aesthetic appearance of all patients was satisfactory and acceptable to all the patients. In two cases, the dorsal graft minimally shifted to one side, but remained straight. In one patient, there was late appearance of distortion.Conclusion:The mode of cartilage warping is predictable and it can be used to advantage. Apprehension to use costal cartilage graft is unjustified, as with precision carving a desired shape can be obtained.

Xipho-omphalopagus twins are conjoined twins sharing some part of gastrointestinal system and lower sternum. These types of twins have best chances of survival if successfully separated. We report a case of successfully separated Xipho-omphalopagus twins, highlighting the importance of proper planning and team effort in such separations.

The spectrum of indications for rhinoplasty in Indian patients is very wide. An ill-defined nose with lack of projection and broad osteocartilagenous framework is the commonest problem. A large number of patients require narrowing of the framework by osteotomies, alar wedge resection,and augmentation by a suitable fill, preferably a cartilage graft. The technique of rhinoplasty in Indian patients with special emphasis on cartilage grafting has been discussed here. Cartilage grafts, when used as a fill, produce soft, natural results.

Background:Post-traumatic nasal septal collapse results in flat, broad, non-projecting nose due to mid-vault collapse. These patients may have airway obstruction due to poorly supported internal valve. Traditional techniques like 'cantilever graft technique' or conventional 'L-graft technique' produce a rigid lobule as the single unit framework extends to the tip. These grafts also lack in internal valve support.Materials and Methods:Twelve patients with post-traumatic nasal septal collapse were treated with three component cartilage framework technique in the past 3 years. The framework was reconstructed in three components-septal, columellar and dorsal onlay; using costal cartilage. If needed, upper lateral cartilage support grafts were also provided.Results:At 6 months' follow-up, all 12 patients were satisfied with the outcome. The nasal projection and dorsal definition were aesthetically pleasing, and there was free natural movement of the lobular part of the nose. One graft was revised for further improvement in outcome. Airway obstruction, when present was also relieved.Conclusion:This technique has distinct advantages over the conventional techniques as the framework of separate components maintains pliability of the lobule, supports the internal valve and offers good control of aesthetic needs.

Background Setting the angle of tip rotation is of utmost importance in achieving satisfactory results in rhinoplasty. Conventionally the upward rotation of the tip requires shortening of the septum by caudal resection and shortening of the lateral walls by cephalic trim of the alar cartilages. The results are usually assessed subjectively. We describe the use of objective parameters to ensure accuracy of nasal tip rotation in patients operated with “cock-up” alar cartilage flaps, a modification of the cephalic trim. Methods Fifteen patients with a long nose having adequate width of lateral crura, desiring a shorter nose with upward tip rotation, were included in the study. Values of preoperative and desired nasolabial angle (from morphed images), and the derived columellar–labial angle were documented. Nasal tip rotation was set to the derived angle and maintained using cock-up alar cartilage flaps. The outcome was evaluated by digital measurements of the nasolabial angle and patients’ feedback by Rhinoplasty Outcome Evaluation (ROE) score. Results Satisfactory tip rotation and an aesthetic supratip area could be achieved. The difference in preoperative and postoperative nasolabial angles was statistically significant (p value < 0.0001). The difference in desired and the obtained nasolabial angle was not significant (p value 0.085). The results were maintained on subsequent follow-up. Conclusion Application of angles in practice and use of K-wire template helps us achieve accurate and consistent results. Cock-up flap is an effective technique—to obtain an open nasolabial angle and a desirable supratip region by making use of tissues otherwise discarded.