CC BY-NC-ND 4.0 · Indian J Plast Surg 2015; 48(02): 123-128
DOI: 10.4103/0970-0358.163043
Original Article
Association of Plastic Surgeons of India

Namaste (counterbalancing) technique: Overcoming warping in costal cartilage

Kapil S. Agrawal
Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India
Manoj Bachhav
Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India
Raghav Shrotriya
Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India
› Author Affiliations
Further Information

Publication History

Publication Date:
26 August 2019 (online)


Background: Indian noses are broader and lack projection as compared to other populations, hence very often need augmentation, that too by large volume. Costal cartilage remains the material of choice in large volume augmentations and repair of complex primary and secondary nasal deformities. One major disadvantage of costal cartilage grafts (CCG) which offsets all other advantages is the tendency to warp and become distorted over a period of time. We propose a simple technique to overcome this menace of warping. Materials and Methods: We present the data of 51 patients of rhinoplasty done using CCG with counterbalancing technique over a period of 4 years. Results: No evidence of warping was found in any patient up to a maximum follow-up period of 4 years. Conclusion: Counterbalancing is a useful technique to overcome the problem of warping. It gives liberty to utilize even unbalanced cartilage safely to provide desired shape and use the cartilage without any wastage.


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