Facial Reconstruction

People who have been affected by traumatic injuries, cancer surgery, or birth defects on the head or neck often undergo facial reconstruction, to restore a normal appearance. Thankfully, there are effective options. Discover the most effective reconstructive procedures.

People who have been affected by traumatic injuries, cancer surgery, or birth defects on the head or neck often undergo facial reconstruction, to restore a normal appearance. Thankfully, there are effective options. Discover the most effective reconstructive procedures.

Written byJolene EdgarUpdated on July 2, 2021
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Facial Reconstruction 754x484
Facial Reconstruction 754x484

Facial reconstructive surgery is an umbrella term encompassing a number of plastic surgery procedures that can restore anatomical features affected by trauma or illness. 

According to Dr. Amanda Dilger, a board-certified facial plastic and reconstructive surgeon in Harwich, Massachusetts, and an instructor in the department of otolaryngology–head and neck surgery at Harvard Medical School, “facial reconstruction refers to operative and nonoperative treatments used to address functional and cosmetic deformities of the head and neck that occur as a result of injury, cancer surgery, illness, or birth defects.” Procedures range from complex skin cancer reconstructions, involving the various layers of the face, to cleft lip and palate repairs to burn management.

Related: 6 Plastic Surgery Procedures Insurance Might Cover

Various cosmetic surgery options can return damaged or irregular facial features to a more natural appearance. 

Facial plastic and reconstructive surgeons tend to subspecialize in specific treatment areas, focusing their training and practice on particular procedures. For the best outcome, it's important to find a surgeon who has the advanced skill set to address your unique concern.

Rhinoplasty (Page Image)Rhinoplasty

surgical

Worth It Rating100%96%90%
Average Cost$11500$1225$8025
Downtime1–2 weeks of downtimeNo downtimeUp to 2 weeks of downtime
AnesthesiaGeneral anesthesiaLocal anesthesiaGeneral anesthesia or local anesthesia with sedation
  • Cleft lip and palate repair usually involves multiple surgeries, staged over a number of years, to correct parts of the face that failed to fuse together during normal embryological development. Cleft lip and palate cases are best handled at a cleft center, where patients can be tended to by a team of experts including a plastic surgeon; a speech therapist; and an ear, nose, and throat doctor. A cleft lip and/or palate are two distinct entities that are often seen together—and their cause is largely unknown. “They can be associated with certain syndromes and disease processes, but most of the time, they’re sporadic and random,” says Dr. Mark Fisher, a craniofacial and pediatric facial plastic surgeon in Westport, CT. There does seem to be a genetic component: “If a parent has a cleft lip, the chance of their child developing one is about 4%,” he adds. According to Dr. Fisher, a cleft palate—or opening in the roof of the mouth—can cause significant speech issues if not fixed before the age of 18 months. Kids with this kind of malformation also have a high incidence of ear infections and related deafness, he says, because the muscles that open their eustachian tubes don’t work properly. In cases where a child has both a cleft lip and a cleft palate, the reshaping of the lip is usually done first, typically when the patient is 3–5 months old. “During that surgery, the lip is brought together to close the cleft—and oftentimes, there’s some work that’s done on the nose as well, because the nose is very much involved in the cleft lip deformity,” Dr. Fisher says. Around 12 months of age, the child’s cleft palate repair begins. There are two major goals: to close the hole between the nose and the mouth and to reorient the muscles of the palate so that they’re able to facilitate speech.  Around age 3, once the child is talking fluently, doctors will evaluate their speech. “If the child is still having trouble closing off the mouth from the nose, to create certain sounds, there are various speech surgeries that can be done around age 5,” says Dr. Fisher. The majority of kids don’t need these, however. If the patient’s cleft palate affected their gum line, surgeons will “take bone from the hip and place it into the gum line, to fill in the gap in the bone and give the adult tooth that is waiting to erupt a healthy environment of bone to come out into,” Dr. Fisher explains. This sculpting surgery typically takes place when the child is between 8 and 11 years old.  The final stage of cleft palate repair, for those who need it, is jaw surgery. “Sometimes the surgery to repair a cleft palate can cause growth disturbances of the upper jaw,” says Dr. Fisher. So some patients, at around age 16 to 18, may need surgery to help bring the upper [mandible] forward and sometimes move the lower jaw back.” Braces or other orthodontic procedures generally precede and follow jaw surgery, to ensure the bite is well aligned. While the downtime for jaw surgery is around four weeks—the lengthiest recovery of the cleft repair process—Dr. Fisher finds patients tend to heal quickly and typically spend no more than one night in the hospital following each procedure. “The complication rate is low, and the success rate is really high,” he adds. “Every step of the process is really life-changing for these kids.” Find doctors who offer cleft lip and palate repair
  • Minor earlobe repairs can address a ripped earlobe or any other anatomical irregularity in the area. “Ear lobes can become stretched or torn from large or heavy earrings, gauge earrings, or an earring being pulled forcefully,” says Dr. Dilger, who commonly repairs such injuries under local anesthesia by first removing any excess skin and soft tissue and then reconstructing the lobe with sutures.  In most cases, the ear can be pierced again a couple months later, but since “the scar will not have the same strength as uninjured skin, it may be prone to tearing again,” she notes.  As an alternative to surgery, a small amount of dermal filler can be injected into the earlobe, to make a stretched piercing site temporarily smaller, Dr. Dilger tells us.  Find doctors who offer earlobe repairs
  • Nasal trauma repair is the ideal craniofacial reconstruction option for those who have broken their nose. “Nasal bone fractures are the most common type of facial fracture,” says Dr. Dilger. If addressed early—within two weeks of the break—surgeons can perform a closed reduction. “Since the nasal bones haven’t healed yet, they can be moved into position without incisions or osteotomies,” she says. Doctors place a tool called a boies elevator inside the nose and a hand on the outside of the nose and move the bones back into proper position. Downtime is one week, with an external cast on the bridge of the nose and two weeks of avoiding vigorous activity and heavy lifting.  For those who delay fixing the fracture, a septorhinoplasty may be needed in order to straighten the septum and nasal bones, Dr. Dilger says. Find doctors who offer nose surgery
  • Skin cancer reconstruction is one of the most common forms of facial reconstruction surgery. Whether benign or malignant, skin cancers of the face—basal cell carcinomas, squamous cell carcinomas, melanomas—have the propensity to grow and invade nearby structures, so they need to be diagnosed and removed early, for the best outcome. “In general, the earlier the diagnosis is made, the smaller the procedure to remove it and the easier the reconstruction,” says Dr. Paul Carniol, a board-certified facial plastic surgeon and the president of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).  “Skin cancer reconstruction aims to restore the lost skin and tissue while making cosmetically acceptable scars,” explains board-certified facial plastic surgeon Dr. Theda Kontis, the secretary of the AAFPRS and an associate professor of otolaryngology–head and neck surgery at Johns Hopkins Hospital.  Such repairs may be performed by a Mohs surgeon (a dermatologist with specialized training in skin cancer excision and pathologic diagnosis), a facial plastic surgeon, or a plastic surgeon, she notes, and “can include simple closures, skin grafts, or more complex movements of the skin, called flaps.” Free flaps are sections of donor tissue (skin, taken from another area of the body, which are then reattached through microvascular surgery.  Ultimately, the approach a surgeon takes will “depend on the area involved, the size of the defect, and the overall health of the patient,” says Dr. Dilger, adding that restoring function of the treatment area and avoiding any sort of deformity of adjacent structures are top priorities during skin cancer reconstruction after Mohs surgery. In rare instances, wounds in certain areas may be allowed to heal by secondary intention—or, essentially, fill in on their own, from the bottom up. But these outcomes are unpredictable and often don’t produce the best cosmetic outcome.  Primary linear closure, or stitching the free edges of the wound together, is a more popular reconstructive technique. “It works best in areas where you have a lot of redundant tissue and bringing it together isn’t going to distort anything nearby, like an eyelid or lip,” says Dr. Dilger.  In parts of the face where pulling the skin closed risks altering other features, doctors will generally repair defects using various free flaps or grafts, aiming to hide incisions within what they call natural relaxed skin tension lines. On the face, these are commonly wrinkles or folds. While reconstruction can be fairly straightforward, with a relatively easy recovery, this is not always the case. “A large or complex wound, such as losing part of the nose, can require a more involved reconstruction, with a longer recovery,” adds Dr. Carniol.  Nasal reconstructions can be quite challenging, “as the defect can involve skin both with or without underlying cartilage or bone and mucosa,” Dr. Dilger explains. “It’s important to replace all the missing layers in order to obtain the best functional outcome [and avoid complications like] collapse or scar contracture, which will impair breathing and likely lead to a poor cosmetic outcome.” These more advanced skin cancer reconstruction cases sometimes require more than one surgery. As with every facial plastic surgery, skin cancer reconstruction leaves scars. “It takes time for them to mature during the healing process,” adds Dr. Kontis. “Scars appear pink, usually for about three to four months, until they mature into thin while lines.”

  • Burn reconstruction is often performed after a patient experiences traumatic burns. Burns can be the result of anything from steam to explosive fumes to fire and electricity—and they can vary in their severity. These factors, along with the location of the burn and affected tissue depth, can affect the cosmetic surgery strategy. “The most frequent burns are minor, first-degree, or superficial second-degree,” says Dr. Carniol. “These typically will respond well to local care. As we look at deeper burns, it becomes a more complex and challenging issue, as deeper burns can require more than one stage of reconstruction and more complex reconstruction, and they can leave visible scars and even a permanent deformity.” Local wound care typically involves keeping the area clean and moist with antibiotic ointments. For more significant burns, reconstructive measures may include excision followed by skin grafts or allografts (with donor tissue), notes Dr. Dilger, followed by wound care, to avoid crusting and infection, plus careful sun avoidance.  “Scar contractures [tightening of the damaged tissue] are common with burns and can reduce mobility,” Dr. Dilger adds. “Stretching and scar massage with physical therapy can be helpful first-line therapies, along with silicone sheeting. Z-plasties are commonly used to release contractures and lengthen and reorient scars so they are less noticeable.”

Skin-care products, particularly topical scar treatments, can be a valuable asset in certain post-procedure care plans. 

If scars are your concern after facial reconstruction, try a topical silicone gel, which has been proven to help minimize the look of new and existing scars. A once-per-day professional scar treatment, like Stratpharma Strataderm, can reduce the redness and elevation of scars. Another option, Skinuva Scar, is a clinically tested cream that pairs silicone with growth factors in order to help reduce postsurgical and post-trauma scarring. 

Of course, it’s imperative that you speak to your provider before using any new skin-care products on areas that have undergone facial reconstruction.

Related: What “Board-Certified in Plastic Surgery” Really Means—and Why Everyone Is Talking About It

Updated July 2, 2021

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