title: Namaste (counterbalancing) technique: Overcoming warping in costal cartilage.
abstract: 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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India.
authors.forename: Kapil S
authors.initials: KS
authors.lastname: Agrawal
authors.affiliation: Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Bachhav
authors.affiliation: Department of Plastic Surgery, KEMH, Mumbai, Maharashtra, India.
authors.forename: Raghav
authors.initials: R
authors.lastname: Shrotriya
keywords: Autogenous cartilage; costal cartilage graft; counterbalancing technique; rhinoplasty; warping