How to treat face depression after parotidectomy?

Question

I just had my near total parotidectomy last week. Doctor said there will be a hollow part on my face when it heals. How can i treat this? Ive read about fat transfer, muscle flap, fillers ( is it botox?) what is the best way and what are the pros and cons?

Anil R. Shah, MD · Answer

There are multiple options for restoring the face after a parotidectomy.  Botox would not be a good option for volume but can help with some patients for Frey's syndrome.  Frey's syndrome is where the parotid gland abnormally innervates to the face and causes sweating to the face.  The parotid gland is removed during a parotidectomy which can create asymmetry in the facial appearance.  Options for repair:
-Sculptra- Sculptra can be a good volumizer and typically has at least a 2 year duration.  Not all patients respond well to sculptra.
-HA fillers- Hyaluronic fillers can be used as an option but tend to come in 1 cc aliquots.  Vollure is the softest and latest of the HA fillers and can last up to 18 months.  Duration may be less for patients near the mobile area of the parotid gland.
-Radiesse- Radiesse is often used to define the jaw angle and may last longer than softer fillers in this area.
-Fat grafting- Fat can be used to provide a larger amount of volume and often mimics the texture of the parotid gland.
-Muscle flaps- Muscle flaps such as an sternocleidomastoid flap are often best done at same time as parotid removal.

Jason Emer, MD · Answer

Fillers, implants and fat can all be used to sculpt the face. Fillers like Radiesse, Voluma, Perlane work great for cheek volumization and contouring. Restylane silk, Voluma, and Belotero work great around the eyes. Long term my patients also get Sculptra injections to help stimulate collagen and make the filler last longer. Fat can also be used which is something I do frequently in my practice. I suggest you see an expert in facial sculpting to determine what is best. Dr. Emer.

William Townley, MD, FRCS(Plast) · Answer

Hi there. Many thanks for your question. In malignant (cancerous) parotid tumours that involve taking out some of the glands of the neck, my favoured approach is to transplant some tissue from the leg (free flap) at the time of surgery - this can give a near perfect contour and helps healing. It can also be done at a later stage. If it is just a benign tumour (without lymph gland removal) - fat grafting after 6 months or so is probably the best approach. This may need to be repeated depending on the initial contour defect and how much fat survives. I would avoid fillers - they do not provide adequate volume and will not work effectively. Good luck!

Peter A. Aldea, MD · Answer

As you pointed out there are multiple techniques to restore facial contour after surgery or trauma. The first thing to do is allow time to reduce swelling and see if the tumor comes back. Once the swelling is gone and there are no local recurrences of the tumor the reconstructive options would depend on the width and depth of the defect. Fat is a great filler but would require more than once procedure. Peter Aldea MDMemphis, TN

Samir Shureih, MD · Answer

After partial or near total parotidectomy, there will be a depression on the side of the face. Treatment would depend on the pathology of the parotid tumor. I would discuss that with the surgeon and the plastic surgeon. and would not do any reconstructive procedure before one year after the parotidectomy. Then evaluate with the plastic surgeon as to the best approach.

How to treat face depression after parotidectomy?

Answers (5)

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