Q: Dr. Eppley, I am very sorry to disturb you, I live in a remote area of Russia, and my grandson was born with craniofacial distortions of his face and skull. My friend found your contact details in the Internet. I have a few questions to you:
1) Is it possible to enhance at the same time (by one surgery) my grandson’s forehead and back of his head? They are both too flat and the maximum distance between his eyebrow line and the back of the head is 14.7 cm only. By how much is it possible to make this length longer?
2) What should it be done with his medium face? Will it be the treatment by implants, or it is possible to put there human grease/fat?
3) What else could you recommend on him ? We know that he also needs the surgeries on his jaws.
4) How much will it cost us to get the above mentioned treatments ( 1) and 2) points) at your clinic in the USA?
Thank you so much for your reply.
A: Thank you for your inquiry. In looking at your grandson’s pictures, it is clear that he was born with some form of craniofacial deformity, most likely one of the craniosynostoses. (Crouzon’s etc) It also appears based on the scars on his forehead that he may have had some initial efforts at craniofacial surgery when he was younger.
While you did not state his age, he appears to be a mid-teenager at least. I will separate his craniofacial concerns for this discussion into cranial (skull/forehead) and face.
From a skull standpoint he has a short front to back distance typical of many congenital craniosynostoses. He is shorter in the back than in the front in my assessment. The back (occiput) can be augmented significantly (up to 2 cms.) and the forehead smoothed out for a better contour. The most relevant issue here is where is his previous coronal (scalp) incision as that will determine how to approach is skull augmentation reshaping.
From a face standpoint there are two directions to go. Ideally he needs pre- and postsurgical orthodontics and a LeFort I midface advancement with a sliding chin genioplasty. The key there is orthodontic preparation. If this is not possible, the second approach is to camouflage the bony deformities by a combination of orbital, cheek and paranasal implants combined with a sliding genioplasty. (see attached imaging) That could be done at the same time as skull augmentation.
The key in any complex craniofacial problem in a mid- to late adolescent is to identify those craniofacial surgery procedures that are most practical to do that provide the greatest physical and psychological change for the patient.
Dr. Barry Eppley
Q: Dear Dr. Eppley, what is the difference between craniofacial and maxillofacial surgery? I am thinking that they use the same surgical procedures and the same materials like bone cement? I am interested in getting my forehead reconstructed from a dent in it due to an injury but don’t know which type of surgeon to go to. And are you practicing both craniofacial and maxillofacial surgery?
A: Maxillofacial surgeons are usually dentists (with or without a medical degree) that have trained in facial bone surgery below the forehead, mainly of the jaws. Craniofacial surgeons are plastic surgeons that have done extra training in craniofacial deformities and have much greater experience in bone surgery above the jaws. Most maxillofacial surgeons will have very limited experience if any in forehead surgery and cranioplasty.
While there are exceptions to either of these types of surgeons and training and experience can vary by country and geographic region, these are general guidelines. I can speak to their differences quite clearly as I have trained and am board-certified in both specialities. You should seek out a plastic surgeon who has considerable experience in cranioplasty and the various materials used to do this type of forehead surgery.
Dr. Barry Eppley
Q: Hi, I am a 16 year-old that is doing at school an assignment called the Research Project. It is where we have to choose a topic and learn about it and, in the end, we have to do a 10 minute oral presentation on it. I was wondering if you could help me with some questions. The question that I am focusing on is ‘How does craniofaical reconstruction change someone’s life?’. And also how would I write a survey for this type of question or topic. I hope that you can help me. I need all of this done in about three weeks so if you could email me that would be good.
A: Craniofacial surgery is a specialized area of plastic surgery that involves the reconstruction of deformities of the skull and face, whether they be from birth defects, traumatic injuries or from various benign or malignant tumors. Much of this work is about the rebuilding or moving of misplaced or missing bones of the face and skull. While not exclusively done in infants and children, much of craniofacial surgery is done early in life when possible to work with the growing face and to help children develop more normal social interactions. While there may be many functional problems that come with craniofacial deformities, creating a more normal looking skull and face helps provide a significant psychological benefit as well. While we may not always like it, how we look and are seen by others plays a tremendous role in one’s self-image and acceptance by society.
If one was constructing a survey on the topic, one would want to ask how the craniofacial reconstructive procedure made them feel after surgery and what specific impact it had on their lives.