Nasal scars are one of those concerns that really cannot be assessed properly through pictures alone. A thorough in-person clinical examination is essential — how the scar feels, how it moves, how it relates to the underlying cartilage and surrounding skin, and whether it is affecting breathing in any way. These are things that simply cannot be captured in an image.

Every case is different.
Treatment planning depends on a number of factors — how long the scar has been there, what outcomes are realistically achievable, how the scar sits in relation to the rest of the face, and whether there is any element of breathing obstruction involved. A scar that looks similar to another may need an entirely different approach.

Treatment options are wide-ranging and may include:
— Scar revision, with or without contracture release
— Fat grafting — micro and nano techniques — to restore volume and improve texture
— Cartilage grafting to restore structural support
— Full thickness skin grafting where surface replacement is needed
— Local or regional flaps for more complex reconstructions
— In select cases, a formal rhinoplasty may actually be the most appropriate and effective way to address the scar in the context of the whole nose

Results take time — and post-operative care matters.
Scar healing is a process, not an event. Once treatment is done, consistent post-operative care plays a significant role in the final outcome. This typically includes diligent sunscreen use, silicone gel application, and in some cases, adjunct laser treatments to refine the result further. Patience is part of the process.

On cost --
Because treatment plans vary so significantly from one patient to the next, costs are discussed only after a proper assessment. There is no one-size-fits-all answer here — the plan drives the cost, and the plan can only be made in person.

If a nasal scar has been a concern, the right starting point is a clinical consultation — not a photo assessment. Call us or visit our website to book yours.

​Learn more about rhinoplasty and scar revision. 

The nose is assessed as a whole, but its proportions are built from individual parts — and the base is one that often goes unaddressed. Alar base reduction is a focused procedure that refines the lower third of the nose, correcting width, flare, or both. It is one of the more quietly transformative procedures in facial surgery — small in scale, but significant in impact.
What exactly is the alar base?
The alar base refers to the width and flare of the nostrils — the lowermost part of the nose where it meets the face. When this area is wider or more flared than the rest of the facial features warrant, it can affect the overall balance of the face in a way that is difficult to pinpoint but easy to notice.
We assess the alar base primarily from two views — the frontal view and the worm's eye view (looking upward from below). From the front, we look at how the width of the nose relates to the distance between the inner corners of the eyes. From below, the ideal nose forms a neat equilateral triangle. When the base is too wide or the nostrils flare outward excessively, this triangle is disrupted, and the nose loses its sense of proportion.
A common complaint we hear — particularly in our practice in Kerala — is that the nose appears to widen noticeably during a smile. This is the alar base expanding with facial movement, and it is something that can be very effectively addressed with surgery. A wide alar base is, in fact, quite common among patients from our part of the world, which makes this a frequently requested and well-refined procedure in our hands.
Flare vs. Width — Two different problems
It is worth understanding that alar flare and alar width are not quite the same thing, and the correction for each is slightly different.
Flare refers to how much the nostrils angle outward. The incision for flare correction is placed at the junction between the cheek and the nose — a natural crease that conceals the scar beautifully. Width correction, on the other hand, addresses how broad the base of the nose is, and the incision here is hidden in the crease at the lower part of the nostril. In some patients, both corrections are needed together.
An important consideration — The nasal tip
One nuance that requires careful judgement is the relationship between the alar base and the nasal tip. Reducing the alar base without accounting for the tip can, in certain patients, make a fuller or rounder tip appear even larger by comparison. This is why the decision to correct the alar base — and by how much — is always weighed against the dimensions of the tip. A thorough assessment ensures that the result enhances the nose as a whole, not just one part of it.
The procedure 
Alar base reduction can be performed as a standalone procedure or at the end of a rhinoplasty, once all other nasal changes have been made. When done in isolation, it is a straightforward outpatient procedure performed comfortably under local anaesthesia — no hospital stay required. Sutures are removed at one week.
Swelling at the base of the nose does take some time to fully settle, and patients should be aware that the final result reveals itself gradually over the weeks following surgery. That said, early results are already visible and encouraging.
What about scars?
Scarring is a natural concern with any facial procedure. The good news is that the incisions for alar base reduction are placed in natural creases and junctions of the nose where scars heal inconspicuously. In our experience, scars are very well accepted by patients and typically become barely noticeable with time.
Can it be done again?
Yes. Secondary alar base reduction is possible for patients who feel they need further refinement, or for those who had a rhinoplasty and want to address the base once the swelling from their primary surgery has fully resolved. We simply wait until the tissues have settled completely before reassessing.
Satisfaction and outcomes
Alar base reduction carries a high satisfaction rate. Because the change is proportional rather than dramatic, results tend to look entirely natural — an improvement that people notice without being able to identify exactly what has changed. For patients who have long felt self-conscious about the width of their nose or the way it changes with a smile, this procedure can be a genuinely meaningful one.
If you would like to understand whether alar base reduction is right for you, we would be happy to assess your nose in detail during a consultation at our clinic in Trivandrum.
​
To learn more about rhinoplasty please click here..

Fat grafting is a technique that uses your own fat to restore volume and improve the appearance of your face. Let me walk you through how doctors harvest this fat in a way that's easy to understand.
Fat grafting can be thought of as a type of transplant, but instead of using donor tissue, doctors use your own fat from one part of your body and move it to your face. This fat can be used in two main ways:
First as "microfat" - small pieces of fat tissue that provide structural support, like adding volume to hollow cheeks or deep wrinkles. Second as "emulsified fat" - fat that's been broken down into a liquid form, which doesn't add as much volume but helps improve skin quality through stem cells found in fat.
Doctors typically harvest fat from your torso (stomach area) or thighs. These areas usually have enough fat to spare and the fat cells from these regions work well when transferred to the face.
The process is gentler than fat harvesting for body procedures (like buttock enhancement) because facial grafting needs less volume and smaller fat parcels. The donor area is cleaned and numbed with local anesthesia using fine needles. Doctors use thin tubes called cannulas (about 2.1 to 2.4 mm in diameter, which is roughly the thickness of a coffee stirrer). The cannula is attached to a small syringe (usually 10 cc, which is about 2 teaspoons). The doctor creates gentle suction by pulling back on the syringe, drawing fat cells into the tube. For facial procedures, doctors typically harvest less than 20 ml (about 4 teaspoons) of fat.
The smaller syringes allow for more precise control and gentler suction than the larger equipment used for body fat grafting.
The recovery from the harvesting procedure is quite simple. The tiny incision doesn't need stitches - it seals on its own within a few days. A small dressing or bandage is applied to the donor area. You might feel some firmness or lumpiness (called induration) at the donor site for a few days. No special aftercare is typically needed beyond keeping the area clean.
Facial fat grafting requires a more delicate touch than body fat grafting because the face needs smaller amounts of fat, the fat must be placed in thin, precise layers, and the smaller harvesting equipment causes less trauma to the fat cells, helping more of them survive when transferred.
This gentle approach to harvesting helps ensure the best possible results when the fat is transferred to the face, where it can help restore volume lost through aging, trauma, or medical treatments like radiation.
Learn more at: Fat Grafting

There is an increasing demand for cosmetic procedures with minimal downtime. The advantages are shorter recovery and the ability to return to normal life. One such procedure is non-surgical rhinoplasty. 

What is a non-surgical rhinoplasty? 
It involves the injection of fillers into the nose to bring about a difference in appearance. It has more in common with a filler injection into the face than with a routine rhinoplasty. The 'rhinoplasty' in non-surgical rhinoplasty comes because the filler is being injected into the nose to alter its appearance.  Non-surgical rhinoplasty is also referred to as liquid rhinoplasty. Why 'liquid'? Because the filler that is injected is a liquid. 

What are the advantages of doing a non-surgical rhinoplasty? 
The main advantage of such a procedure would be the minimal downtime. Since fillers are injected the time taken to complete the procedure would be very short and would not need any hospital admission. 

What can be achieved with non-surgical rhinoplasty?
Compared to a surgical procedure, the benefits of a non-surgical procedure are limited. The benefits of a non-surgical rhinoplasty include, 

1. Volume enhancement. The root of the nose (radix) and the dorsum can be enhanced with filler injection. 
2. Improve a drooping tip 
3. Improve minor asymmetry and camouflage small defects 

What are the changes that can't be achieved with rhinoplasty? 
It is not possible to make a large nose smaller using injection non-surgical techniques. It is also not useful for the management of a bulbous tip. It is not possible to improve septal deviations with non-surgical rhinoplasty. Surgical rhinoplasty is the gold standard for the management of the deformities of the nose. 

How long does the effect of non-surgical rhinoplasty last?
When compared to a surgical procedure, the effects of non-surgical rhinoplasty are temporary. In most cases, hyaluronic acid fillers are injected during this procedure. Hyaluronic acid breakdown with time. The effects may last approximately one to two years. In certain individuals, the effects tend to last for a shorter period. In case of an unfavourable result, it can be removed with the help of a hyaluronidase injection. 

What are the risks associated with non-surgical rhinoplasty? 
The risks associated with a non-surgical rhinoplasty are similar to those seen with filler injections into the face. These can include tissue death and involvement of the vessels of the eyes and brain. Skin necrosis results due to impaired blood supply of the skin. Embolization of the filler into the vessels of the eyes can lead to blindness. These adverse events have been reported with filler injections, they are uncommon. 

Who is a good candidate for non-surgical rhinoplasty? 
It would include patients who want a change in the appearance of the nose without any downtime or need for aftercare associated with a conventional rhinoplasty. Patients should have realistic expectations and understand that not all deformities can be improved with a non-surgical rhinoplasty. The effects are temporary and need repeat injections for maintenance of the results. 
For more information about rhinoplasty please visit: www.amicusclinic.in/rhinoplasty

Rhinoplasty is a commonly known plastic surgery procedure to improve the appearance and function of the nose. The function of the nose relates to breathing. As in all surgical procedures, complications can happen. The goal of preoperative evaluation is also to seek out any potential problem. But despite the best efforts, complications can occur. 


The incidence of the complications varies. It can vary depending on the type of procedure, and patient factors. It is more common to have a greater incidence of complications in difficult (challenging) cases. Some of the complications are uncommon when compared to others. The complications can be seen under those that are nonspecific to rhinoplasty and those specific to rhinoplasty. 


The nonspecific complications can occur in any surgical procedure. It need not be in rhinoplasty alone. These include, 

• Infection: These are uncommon in rhinoplasty. But when they happen, they tend to be serious and can impair a surgical outcome. 
• Prominent scars: These are uncommon. However, more common would be a scarred appearance of a nose that has undergone multiple rhinoplasties. 
• Delayed healing

The specific complications of rhinoplasty are those related to aesthetic (appearance) and functional (breathing).


The aesthetic complications include, 

• Asymmetry: This could be a worsening of a pre-existing asymmetry. 
• Dissatisfaction with the appearance. This could be due to the appearance of the tip, dorsum, projection, width, base, and various other parts of the nose. It is a reason for revisionary or secondary corrections. 

Swelling is usual after rhinoplasty. The various layers of the nose are swollen. This includes the outer skin, lining mucosa, and the structures in between these two layers. Swelling subsides with time. Even though most of the swelling settles by a month, the residual swelling lasts longer. This can take about a year or longer to subside. Hence, any decision to undertake revisions is taken after this period.  


Functional problems associated with rhinoplasty include, 

• Difficulty with breathing. It is common to have difficulty in breathing during the initial weeks due to swelling of the inner lining of the nose. There would be an improvement in the breathing as the swelling subsides. So any evaluation for persistent difficulty in breathing is carried out after this period. 
• Septal perforations. The septum is the midline structure that separates the two sides. This can undergo perforations. This is more common in previously operated noses. Septal perforations of the posterior (back) and those that are asymptomatic are usually left alone. The symptomatic perforations can need revisionary procedures. 

Some of the complications are more serious when compared to others. Also, the difficulty level in performing a rhinoplasty can vary depending on the presentation. It is also more so in previously operated noses. It is not possible to eliminate the possibility of complications. However, it is usually possible to reduce their incidence with careful planning and attention to detail. 

For more details about rhinoplasty, visit here. 

Pushback otoplasty is done for improvement in the appearance of prominent ears. It is usually carried out under general anesthesia in children and local anesthesia in adults. During this procedure, ear cartilage is removed and reshaped so that it lies closer to the head. It is carried out either as a short stay or outpatient procedure. Pain is controlled with the help of oral medications.

After the procedure, a dressing is given in the form of a head wrap with a bandage. The ears are inspected on the first postoperative day for the presence of any collection. The bandages are retained for a week.

At the end of the week, the dressings are removed. Patients can shower once the dressings are out. For two weeks following the procedure, a headband is advised to be worn constantly. After this period, a headband should be worn during the night.

It is common to have swelling of ears following surgery. This gradually subsides over time. Most of the swelling disappears by the end of a month. Pushback otoplasty is a cosmetic procedure. It does not alter the hearing.  It helps individuals with prominent ears to obtain a better body image.

Click here, for more information on otoplasty.

Hello, is this the plastic surgery clinic?
Yes.
Do you perform rhinoplasty?
Yes, we do.
What is the cost of rhinoplasty?
We need to see you before we comment on the treatment plan or the cost.
Is it possible to give a rough estimate?
…….

We tend to have the above conversation multiple times. Sometimes rhinoplasty gets replaced by another procedure such as liposuction, fat grafting or something else. I thought of elaborating more about our resistance to comment on treatment costs before seeing the patient.

Imagine a person with a desire to build a home. Not an apartment in a high-rise, but someplace on a piece of land with a small garden. Such a person would have certain ideas about size, location, immediate vicinity, style, etc. And if there is a lack of clarity related to these aspects she would assume that she would be guided by an expert. Now let's imagine another conversation.

Hello, is this the builder's office?
Yes.
Do you build homes?
Yes, we do.
What is the cost of building a home?
……..

We find both these conversations very similar. Because we are dealing with situations in which making plans would not make sense without a good grasp of what the customer needs. In other words, both cosmetic surgery and building a home are highly customized endeavors. There are a lot of variables which need to be sorted out or understood before we finalize a plan. In both cases, the expert brings to the table his or her expertise. Once a plan is finalized it is reasonable to arrive at the cost.

 It is nearly impossible to follow a cookie cutter approach in cosmetic surgery. Let me give an example. Let us assume an individual seeking rhinoplasty. Following a clinical examination and discussion, we usually arrive at a treatment plan. A plan found suitable for one person may be quite different from a plan for another individual. One may require a short procedure lasting one hour whereas the other may require something much more complex lasting six hours. The cost, in turn, depends on the complexity and duration of a treatment procedure.

Like an architect who seeks input from her client, we give a lot of importance to input from our patients. This more so in cosmetic surgery when compared to other surgical specialties. Because of this, a similar looking deformity may get treated using different techniques. One individual may be satisfied with a simple correction whereas another may be keen on a more exacting remedy. This again reflects on the cost of the procedure. This sort of variability in treatment options applies to almost procedures in cosmetic surgery.

 Because of these reasons we hesitate to comment on any treatment plan when certain pictures or images are sent to us. We do get an approximate idea of the deformity with the images, but in the absence of a discussion with the patient, it does not make much sense to decide on a treatment plan. Also, a clinical examination gives a lot of important and useful information relating to the management of the condition. These are not otherwise apparent by inspecting images of the body part. To give an example, in rhinoplasty we get to assess aspects like the thickness of the skin and soft tissue, structural support, status of the nasal cavity as well as nasal obstruction with a clinical examination. These can't be inferred from the pictures.

It may sometimes be possible to give an estimate of the cost when a procedure is simple or straightforward. This applies to procedures like excision of a mole with a straight-line closure or repair of an earlobe cleft. This can also apply to procedures like hair transplant when the cost can be correlated in terms of a smaller unit say, cost per follicular unit.

All of the above reasons lead to a reluctance to comment on the cost of a procedure without a clinical examination and discussion. I suppose similar reasons would also apply to those who seek to get a home built somewhere.

Deep wrinkles of the forehead are commonly seen in an aging face. They are usually seen in the area between the eyebrows. They tend to give a serious look to the affected individual. In the beginning, these wrinkles become apparent during facial expressions. Later on, they become fixed and are constantly present. Lowering of the eyebrows can be associated with the appearance of these wrinkles.

Because of their position, these wrinkles are immediately apparent to an onlooker. The wrinkles are as a result of the contraction of underlying muscles of the forehead. The skin becomes thin with age and as a result of the contraction of the underlying muscles, the overlying tissues gets folded in like an accordion. These wrinkles can be improved by both nonsurgical and surgical techniques.

Nonsurgical treatments:

This is comprised of injections with botulinum toxin and dermal fillers. The nonsurgical procedures are preferred by many as these are performed as outpatient procedures. They do not have a downtime and patients can get back to their routines soon after the procedure.

1. Botulinum toxin injection:

Botulinum toxin acts on the junction between the nerves and muscles to prevent transmission of impulses. This causes relaxation of the forehead muscles which are responsible for wrinkles. A small needle is used to inject to treat the targeted muscles. The full effect of the injections takes approximately one week. The effect lasts for around six months. For continuing action, these injections need to be repeated once the effect wears off.

2. Filler injections:

As the name suggests they 'fill up' areas. As we age we undergo volume loss of the soft tissues. This includes the skin and deeper tissues of the face. Fillers counteract these changes by addition of volume. There are various fillers which differ based on their constituent molecule, and duration of action. The most commonly used fillers are made of hyaluronic acid. They are injected into the skin with the help of fine needles. They soften the wrinkles by making the skin firmer. Filler injections can also be used at a deeper level adjacent to the bones.

Deep and static wrinkles of the forehead usually need treatment with a combination of fillers and botulinum toxin injections.

Surgical treatment:

Unlike nonsurgical treatments, surgical therapy is more invasive. A brow lift is a technique used for surgical rejuvenation of the forehead.

Brow lift:

A brow lift is also known as a forehead lift. It addresses age-related changes such as:
1. the wrinkles of the forehead,
2. the wrinkles between the eyebrows,
3. the lowering of the eyebrows. It results in a higher resting position of the eyebrows and,
4. improves the hooding of the eyelids as a result of the lower position of the eyebrows.

A good candidate for a brow lift would be one who is in good health, has reasonable expectations about the procedure and is a non-smoker.

A brow lift is performed under general anesthesia. The incision is placed usually behind the hairline. The tissues of the forehead are elevated to a higher position and excess skin is trimmed away. Brow lift requires an overnight stay in the hospital. A drain may be placed temporarily to prevent collection at the operated site. The sutures are removed at ten days. Patients can return to work at the end of a week. Most of the swelling following brow lift abate by the end of one month. The results of the brow lift, though invasive last much longer than the office-based procedures.

Deep wrinkles of the forehead can be managed effectively both by means of simple office based procedures and a surgical brow lift. They vary in their indications, downtime, and permanency of results.