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Rajbhandari et al. Plast Aesthet Res 2019;6:8 I http://dx.doi.org/10.20517/2347-9264.2018.86 Page 5 of 10

Figure 6. Powered instrument with cutting burr is used to carve the costal cartilage if it is calcified

Figure 7. Partially calcified costal cartilage is sculptured according to the silicone implant

Figure 8. Intra-operatively, an L-shaped silicone implant is seen after opening the fibrotic capsule

grafts, caudal septal extension graft). The posterior aspect of the rib lies over the nasal area (over the nasal
bones and cartilaginous dorsum) and is carved to blend with the underlying nasal framework. Asians have a
rather low radix height. To ameliorate this, we carve the superior aspect of the graft in an uphill-converging
manner, which rests effortlessly over the underlying bone, forming a new, enhanced radix. The undersurface
of the graft is carved with a No. 10 blade in an inverted, flattened out “U” fashion, along the natural contour