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Plastic and Reconstructive Surgery: Facial Reconstruction
Our face is easily the most recognizable part of our body. It may not define us, but it reflects our ancestry, parent’s features and our experiences, not to mention our feelings and our expressions. When our face is changed by disease, injury or an accident of birth, surgery can help to restore it to its original or natural appearance.
The face is also the center of many functions. Five senses (vision, hearing, smell, taste and touch) are centered in the face. Functions such as breathing, eating, smiling, talking all occur around our face.
The “Plastic” in Plastic Surgery comes from the Greek word “Plasticos” which is to mold and to shape. Plastic surgeons use a variety of techniques and procedures to mold and shape tissues. The ultimate goal of facial reconstructive molding and shaping is to improve form and function. Drs. Chang and Vander Kolk believe the aim of both reconstructive and cosmetic surgery is to work with the patient to achieve your goals regarding this important part of your body, the face. Whether the face has been altered by a birth abnormality such as cleft lip and palate, disease such as skin cancer or trauma, or even the results of time as seen in facial aging, the physicians of Plastic and Reconstructive Surgery at Mercy use their extensive experience and clinical expertise to help patients realize their full potential in life.
Plastic and Reconstructive Surgery at Mercy specializes in the following facial reconstruction procedures:
Cleft Lip and Cleft Palate
Cleft lip and/or cleft palate is the 3rd most common birth abnormality seen in infants. It is unique among birth defects in that it affects so many tissues and functions. From the nose, to the lip, the gum, the palate and the ears, these tissues are important for smiling, speech, kissing, eating, swallowing, and hearing. Each child’s deformity is carefully analyzed. Based on Dr. Vander Kolk’s 20 years of experience with hundreds of children, a treatment plan is developed. The treatment plan starts with cleft lip and or cleft palate surgery for infants. As a child grows, treatment encompasses care for speech, dental development in the early years and dealing with a facial difference in the teenage years.
Dr. Vander Kolk’s motto for cleft lip and palate children is to help them “be all that they can be.” This involves the expertise of multiple specialists at Mercy including Ear, Nose and Throat specialists, Pediatric Dentists, Speech Pathology and Pediatric Anesthesia.
Cleft Rhinoplasty
Rhinoplasty surgery requires years of experience, technical expertise and a creative focus to handle the broad complexity of these congenital deformities. While these reconstructive procedures seek to improve function (breathing and smell), there is the additional challenge to provide the best possible appearance for each child. This requires an understanding of each individual child, his family history and the family nasal appearance and the anatomy that has been distorted by the cleft abnormality. Whether their nasal anatomy is one of a unilateral cleft where the goal is symmetry or bilateral cleft where projection and definition are needed, the goal is the same, the best possible form and function.
Ear Deformities
Ears come in many shapes and sizes. When they are partially absent from birth, injured in accidents or a portion taken away with cancer, reconstruction is an option. This involves skin grafts, or cartilage grafts or just local flaps. In some cases, an artificial ear is indicated and this also often requires surgery to fit it into place. Shape changes are a relatively common birth deformity. An otoplasty is a procedure that reshapes and/or resects the cartilage that sticks out causing the ear to be prominent or “dumbo” like.
Eyelid Abnormalities
The eyelids have the thinnest skin and the most delicate muscles of the body. Some patients who come in for cosmetic concerns of their face, actually have excess skin or brow tissue that obstructs their vision. When this limits vision, insurance will cover a blepharoplasty or brow lift. Other times, the muscles that open the upper eyelid are weak resulting in ptosis (or lazy eyelid) that make people appear tired. These muscles can be tightened or repaired resulting in better vision and a more natural appearance to the eye. In more complex cases, Dr. Vander Kolk works with Dr. Rowen, an oculo-plastic surgeon at Mercy.
Musical Injuries
Horn players place tremendous pressure and tension on the muscles of the lip and around the mouth. In rare cases, this pressure and tension can result in injury, tearing and even rupture of these muscles. When conservative rehabilitation is unsuccessful, trumpet, trombone and French horn players have consulted with Dr. Vander Kolk. While a rare type of injury, it can be devastating to someone who’s career (like that of a professional athlete) revolves around his ability to finely control the muscles that make up his embouchure and his or her ability to play their chosen instrument. In select cases, reconstruction of the injured muscles can improve the patient’s horn playing and allow him or her to return to full use of the muscles and make music.
Nerve Weakness or Paralysis
The facial nerve is the nerve that tells our facial muscle to smile, frown, blow kisses or close our eye. When injury (MVA), tumor (brain or salivary) or a birth defect causes the nerve not to work, paralysis of the involved side of the face occurs. Reconstruction options include repositioning the sagging tissues, grafting the nerve and muscle, closing the eyelid with a weight or sutures, or repairing the nerve or muscles. Often this can provide dramatic results in appearance and function (decreasing eye irritation, drooling and abnormal speech).
Septoplasty and Rhinoplasty
Reconstructive rhinoplasty is done for form and function changes that occur naturally, as a result of trauma, or occasionally due to tumors. Frequently, Dr. Vander Kolk does a secondary or redo rhinoplasties to correct deformities that have been incompletely corrected by previous surgery. Specific procedures include:
- Septoplasty— the reshaping of the deformed septal cartilage that alters or interrupts the flow of air with breathing.
- SMR or sub mucous resection of blocking septal cartilage— removes the cartilage completely (and often transfers it to other parts of the nose to further improve function or shape). The most common use of the resected cartilage is in a nose that has been fractured or had previous surgery that results in collapse or bending of the nose. The resected septal cartilage is used as a strut (similar to an I- beam in construction) that keeps the tissues and the nose from bending. Turbinates in the nose help to warm and add moisture to the air we breathe. When the septum is deviated, the turbinates often increase in size as a form of compensation. When the septum is corrected, the turbinates must be treated by fracture or partial removal in order to maximize the size of the nasal airways.
Speech Problems
Speech problems most commonly occur in cleft palate patients. Therapy is the first choice, but when this is unsuccessful, surgery to help the palate work better is indicated.
For more information on these and other reconstructive procedures, please follow the links below:
Now Accepting New Patients.
Most Insurances Accepted.
Please call for an appointment.
Phone: 410-332-9700
Tollfree: 1-800-MD-Mercy
(1-800-636-3729)
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