Facial and nasal reconstruction can be performed in the event of a birth defect, trauma, disease, or another condition. Facial reconstruction can include a wide range of procedures, depending on the patient’s individual needs and goals. Dr. Eric Payne, our extensively trained plastic and craniofacial surgeon, works in concert with a skilled team of medical specialists from a broad array of fields. Each treatment plan is tailored to enhance a person’s outcome, and we utilize some of the most advanced techniques and technology available to provide unparalleled management at every stage. Many of our patients are young, and we understand that surgery can be a very stressful and emotional experience for the individual as well as their family. We make every effort to deliver compassionate, supportive, and uncompromising care throughout the process.
Facial reconstruction surgery is designed to restore and to reshape the structures of the face, head, and neck to improve the function and aesthetics of these areas. In some cases, it may be performed to enhance self-esteem, or it may be performed to achieve a more normal appearance. Facial reconstruction may be recommended after an injury or illness, or due to the presence of birth defects.
Craniofacial surgeons, plastic surgeons, and facial plastic surgeons are typically the physicians that perform facial reconstruction surgery. These specialty fields require training in the structure of the face, head, and neck, allowing them to provide results that are not only natural-looking and aesthetically appealing but also work as designed and do not impair the function of any important features. Dr. Payne is a craniofacial and plastic surgeon who has extensive training in the repair and reconstruction of the face, head, and neck using the latest techniques and technology. From simple modifications to complex restorations, he can help you address your concern or the concern of someone in your family.
Although they share some attributes with cosmetic procedures, facial and nasal reconstructions are intended to provide first and foremost a medical benefit. These procedures are therefore usually covered by most insurance plans, though we recommend confirming your policy coverage by speaking with your health care representative. If you are working outside of the medical insurance system, we may be able to help you find financing options from reputable lenders. In either case, we will review the full cost of your treatment plan during your consultation, so that you can remain well-informed.
Dr. Payne and his comprehensive medical team address a broad selection of concerns using the latest approaches. Some of the procedures we provide include the following:
Rhinoplasty and septoplasty are designed to improve the appearance and function of the nose. In addition to modifying the shape of the bridge, nostrils, tip, and other external areas, rhinoplasty can also improve breathing by changing the shape of the nasal passages, primarily the septum.
In complex cases, staged rhinoplasty may be necessary. Secondary or revision rhinoplasty is performed to further enhance the results of a previous rhinoplasty surgery, or to alter the results if the initial operation did not achieve the desired outcome.
Mohs micrographic surgery is a leading tissue-sparing technique to remove cancerous material from the skin. Even so, patients who undergo this life-saving treatment may still have significant unwanted physical changes in their appearance. Once the cancer is excised, reconstruction to return the treated area to a more normal appearance can begin.
Facial traumas, typically fractures and lacerations to the jaw, orbits (eye sockets), nose, cheek, forehead, or skull, must be competently addressed to ensure full and proper healing, particularly in children and adolescents. The severity of the injury determines the type of treatment, surgical or non-surgical, that can best address the issue.
Distraction osteogenesis is the process of cutting bone and separating it to lengthen the tissue. This often occurs over several staged treatments to achieve the desired bone size and may include several cuts to obtain the appropriate degree of expansion.
An undersized lower jaw, or micrognathia, in an infant can cause sleep apnea and other serious conditions. Neonatal mandibular distraction is a technique used to enlarge the mandible, or lower jaw, to allow for easier breathing. A small jaw can cause the tongue and other oral tissues to obstruct or block the airway, most commonly during sleep. By moving the jaw forward and increasing its size, these tissues can be positioned in such a way that they no longer impede air flow. This surgical treatment allows for avoiding a tracheostomy or improving airflow for breathing so that a tracheostomy can be removed.
During surgery, the jaw bone will be surgically fractured or cut (creating a distraction gap) on both sides and a device will be placed on either side of the face, held in place with pins. The pins are daily “turned” to separate the jaw bones and increase the size of the mandible until reaching the desired outcome. Bone will gradually fill in between the cut portions of the jaw (osteogenesis), enlarging it. Some children may remain in the PICU (pediatric intensive care unit) or hospital for the duration of the procedure, and some patients can recover at home. If the child returns home, specific instructions for feeding, care, and pin turning will be provided by Dr. Payne. Your child’s comfort and results are our highest priorities, and we make every effort to offer compassionate support at each step of your baby’s treatment.
Typically, a facial nerve injury should be repaired within 72 hours after injury with a direct repair or nerve graft. Sometimes the nerve is injured and is not noticed until a period of time later. If this is the case, facial reanimation can be attempted.
Facial reanimation involves assessing what works and what does not. The issues that typically need to be resolved are eyelid closure to protect the eye and cornea in addition to oral lip closure to prevent drooling. Most patients also want improvement of facial deformities that occur with significant distortion secondary to the paralysis on one side. The asymmetry involved causes a distorted smile and eyelid closure can cause significant distress.
Facial paralysis can be a congenital condition or develop as a result of trauma or disease, and it can affect one or both sides of the face (unilateral or bilateral). This procedure can sometimes be completed in a single stage; however, a two-stage technique may be necessary, depending on the needs of the patient. In general, full recovery takes between six months and one year.
The types of reconstruction can be divided into dynamic and static reconstruction. Dynamic reconstruction is the use of muscle transfer to create a smile or closure of the eye. Static reconstruction involves using a gold weight for eyelid closure or fascia for elevating the corner of the mouth. Static means not moving. Sometimes nerve grafts are needed to provide stimulation to muscles.
To achieve the desired outcome, muscles and tendons – typically sourced from the legs and/or abdomen – can be transferred to the face to replace malfunctioning, non-functioning, or missing tissues. Additionally, nerve grafting can help restore movement and sensation, making muscles easier to control. Nerves can be harvested from a wide range of bodily regions, including the calf and other areas of the face. This complex process requires a great deal of skill to complete, and Dr. Payne has the extensive training and experience required to perform the operations. Furthermore, he works with an accomplished team of medical professionals to provide exceptional care at every stage of treatment.
In patients with midface hypoplasia—a condition in which the eye sockets, upper jaw (maxilla), and cheekbones have not grown at the same rate as the rest of the face—a number of issues can develop. Examples of common concerns include sleep apnea, bite misalignment (malocclusion), and dry eyes. If severe enough, midface distraction can be used to correct midface hypoplasia to improve the size and shape of these facial areas and achieve a more regular appearance and function. Distraction involves cutting the affected bone, separating it a small degree, and allowing new bone to grow between the spaces, gradually enlarging the size of the treated area. Where and how the bone will be modified will depend on your child’s unique needs and condition. Midface hypoplasia commonly is associated with craniosynostosis, particularly Apert syndrome, Crouzon syndrome, and Pfeiffer syndrome, to name a few. Other syndromes such as Binder’s syndrome and children born with cleft palate can also develop severe midface hypoplasia. The process of distraction and osteogenesis (bone growth) typically takes several months, with final results taking up to a year or so. Some patients may require multiple operations depending on their expression of hypoplasia and individual needs.
It is important to note, many children do not find the distraction process especially painful, likening it to having braces (and often saying it’s less uncomfortable than that experience). While this procedure can be very emotional for everyone involved, our team will take care to help you and your child feel as at ease and as supported as possible.
Mandibular distraction is designed to generate new bone by increasing the distance between divided segments of the mandible, or lower jaw bone, which causes new bone to form in the gap. This operation in patients over the age of infancy is performed in a similar manner as neonatal mandibular distraction. In many cases, the differences can include the amount of time needed to fully heal and the length of the hospital stay. This technique can be used to address a smaller than normal lower jaw (micrognathia), a recessed lower jaw (retrognathia), and abnormal positioning of the upper and lower jawbone (malocclusion). The approach used will vary depending on the individual needs and condition of the patient. An orthodontist often is consulted in these cases to help provide the best possible outcome. Mandibular distraction may be a part of the treatment plan for individuals suffering from a wide range of disorders such as Pierre Robin Sequence, Treacher Collins syndrome, hemifacial microsomia, and others.
