Facial Reconstructive Surgery

Facial reconstruction is a set of procedures that focus on restoring the normal appearance, function, and correcting deformities on the face. The procedures consist of reconstructing abnormalities which occur as a result of:

• Cancer
• Congenital deformities
• Disease
• Developmental abnormalities
• Certain infections

Facial reconstruction surgery is carried out to reform the physique on the face, which includes the cheekbones, chin, nose, ears, and neckline in general.

Facial cosmetic surgery and facial reconstructive surgery share similar traits. This is because the end goal of both of them capitalizes on having the highest possible cosmetic results regardless of the surgical technique used, which as a result creates a normal or close to normal appearance, as well as improving the patient’s self-confidence, in addition to restoring function, which is the case in facial reconstructive surgery.

Types of Facial Reconstructive Procedures

There are various types of face reconstructive surgeries that are done depending on the part of the head/face and how the said deformity has occurred. These include:

Facial Paralysis Reconstruction

Facial paralysis occurs when an injury or condition leads to inability to be able to move the facial muscles partly or completely. The patient may find it difficult to smile, blink, speak, swallow properly and may have nasal blockage, which would therefore lead to the need for the treatment.

The most common technique used in facial paralysis reconstruction is nerve grafting, which involves transporting healthy tissues from one part of the body that has fat, nerves and tendons to the target area where muscle movement is lacking. The procedure aims at lifting the lips to bring out a visible smile, lifting the packed fat cells that are located at the cheek, as well as the corners of the mouth.

Some of the procedures involved in transferring muscles, nerves and tendons to the face through extraction from other parts of the body include:

• Gracilis muscle (Goose Foot) transplant, which involves transfer of a small portion of thin muscles from the inner thigh to the face.
• Cross-Facial Nerve graft, which involves moving a nerve from one side of the face to another side to enhance nerve fiber to grow to a new healthy nerve.
• Temporalis tendon transfer: this involves cutting a muscle and its bony attachment from one side of the face and transferring it to the lip and cheek to reanimate the face.
• Hypoglossal nerve transfer, whereby the twelfth cranial nerve is relocated from the tongue to repair the paralysis of the face by reconnecting two nerve ends.
• Masseteric muscle transfer, whereby a masseter muscle is repositioned and inserted to a mandibular angle to reverse the facial paralysis.

Ear reconstruction (Otoplasty)

Ear surgery involves the reconstruction of the shape of the ear with the goal of reforming an ear from an injury, surgery or defects from birth. Ear reconstruction focuses on the rehabilitation of tumors, infection or inflammation of the ear, hearing loss, deep skin cancers that have captured the ear, tumors of the auditory system, as well as reshaping misshapen or prominent ears.

Depending on the concern to be addressed on the said ear, the need for skin grafting or cartilage would make it necessary to have more than one procedure. The procedure uses local anesthesia or a topical anesthetic if it’s a mild case. The discomfort faced after a successful ear reconstructive procedure would only be the inability for the patient to lay on the side to avoid putting any pressure on the ear(s).

Mohs Reconstruction

Mohs surgery, which was developed by a general surgeon known as Frederic E. Mohs in 1938, is procedure that is used in treating thin layers of skin that contain cancerous cells. It works by removing the developing tissues. These cancerous cells are examined as they are removed until the surgeon reaches the cancer-free tissues. The areas that have incisions are reconstructed by doing a Flap Surgery (closing the incision by using surrounding tissues) or skin grafting (removing skin from a part of your body and placing it on the treated area). This allows for the growth of healthy tissues, which addresses the appearance is addressed and the contours on the face are repaired and restored.

In aftercare treatment, it is always recommended that the patient adheres to the follow up schedule of appointments with the doctor so that the healing process is observed.

Congenital Defects of the Lips/Cleft Lip

Congenital defects of the lip are defined defects that occur at birth. This deformity occurs when bones and tissues inside the mouth do not merge well leading to a space forming on the upper lip/palate (that’s why the condition is mostly referred to as cleft lip palate). Congenital defects commonly occur when a child has reached nine months to one year, while cleft lip occurs from birth.

These reconstructive procedures for these defects are performed with the goal of minimizing the scars formed by hiding the said defect in a natural way. For the cleft lip, the reconstructive surgeon performs a procedure which joins the two sides of the lip, and while the healing process takes place while the tissues are joining together the scar becomes less prominent and eventually heals. In the congenital defect, the gap in the palate is filled by transferring tissues from one area of the body to the target area. Dissolving stitches mostly used but conventional stitches can be also used and then removed after a week.

A certified face reconstructive surgeon or an Otolaryngology doctor are the most qualified professionals to perform this procedure. Efficient and close care for the child’s recovery by the parents or guardian is very highly recommended because of the after-procedure side effects such swelling, bruising, nasal congestion and bleeding from the mouth or nose.

Nasal Reconstruction

A nasal reconstruction procedure is required if there has been a nose trauma, congenital defect, what is referred to a ‘Rhinoplasty gone wrong’, or when there has been damage left on the nose after the patient has gone through a skin cancer surgery. The defect could be very intensive, as a result of a substantial tissue loss.

If the defect is as a result of Mohs surgery for skin cancer treatment, then the reconstruction on the nose takes place a few days after.

There are different ways of nasal reconstruction, which include:

Skin grafting: This is a procedure that is done when the damage on the skin from the Mohs surgery or trauma is too large. Skin is transferred from one area of the body to the target area on the nose that has an incision.

Flap surgery: This is a procedure where the skin is stretched within the area of incision and stitched to maintain its own blood supply. This is done when the incision is not as substantial.

Staged procedure: This is an operation done in parts. A process called forehead flap is undertaken whereby an expander is placed under the forehead to stretch the skin. The skin grows gradually, and when it fits the size of the deformity, it’s used to cover the wounded part of the nose. The outcome is natural healing.

Skull Based Surgery

Skull based surgery is a reconstructive procedure undertaken to terminate a tumor or other growth formed at the bottom of the skull, such as a sino nasal tumor, brain tumor near the pituitary gland, hernias in the brain and some other birth defects.

A surgical removal of a bone flap from the skull is done with specialized tools. During the procedure, the bone is then restored with a bone graft or other materials, which are exclusively fitted. This procedure is known as craniotomy. After the procedure, the patient stays in the hospital for 3-7 days for observation because it’s one of the more complex procedures.

Another procedure done is endoscopic where the surgeon inserts a thin tube, which has a high-clarity camera and light, through the nose to see and extract the said tumor. This is a minimally invasive procedure and recovery is faster with less complications.  A packing material, antibiotic ointment and nasal spray is put in the nose to moisten the nose and reduce any bleeding that may occur.

Pre-Op Guidelines

Facial reconstruction surgery is best performed by a qualified and experienced plastic reconstructive surgeon, dermatologist trained in Mohs surgery, otolaryngologist, and audiologist. A detailed consultation with the expert in questions is highly recommended, which can happen multiple times before the reconstructive procedure takes place. During the consultations, the reconstructive surgeon will evaluate patient, discuss on what the patient aims to achieve, the different techniques and approaches, the benefits of the procedure, the risks involved, the outcome and finally the recommended approach for optimal results, and why.

Post-Op Guidelines and Recovery

For safe, faster, and optimal recovery after a facial reconstructive surgery, the patient should follow all the recommendations made by the reconstructive surgeon, from taking care of the wound, prescribed medications, follow up on the doctors’ appointments, the dos and don’ts, and what to watch out for in cases of emergencies.

Get in Touch

Reconstructive surgery at Kings College Hospital Dubai focuses on the safety and care of every patient in a compassionate environment with state-of-the-art facilities. To book an online or in-person consultation and a detailed evaluation by one of our world class plastic and reconstructive surgeons in Dubai, get in touch using the contact details given, and our patient-care staff will book an appointment for you.

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