Q: Dr. Eppley, I need advice for facial reconstruction. I had surgery consisting of a left partial maxillectomy to remove a muco-epidermoid carcinoma. (intermediate grade).
Since then, my face have partially distorted as per current picture. Could you please suggest what type of procedure is good for me , to have a better natural handsome look. Could you please recommend the best option and how the procedures are carry out.
A: Thank your for your inquiry regarding facial reconstruction and sending your pictures. The key question is whether you have undergone any radiation treatments to your face after your cancer resection??
Your face is collapsed inward on that side due to lack of underlying bone support from the maxillectomy. Replacing that bone and rebuilding that side of your face would require a complex form of reconstruction known as a free flap as there is inadequate soft tissue to cover any bony reconstruction. This would be particularly necessary if you have had radiation treatments.
A simpler and less complex form of reconstruction would be to focus on building up the soft tissues through fat injections. This can be done whether you have had radiation treatments or not.
Dr. Barry Eppley
Q: Dr. Eppley, I reached out to you last year regarding a consult for reconstructive facial surgery following an ATV accident several years ago. Since I have had several reconstructions and am now looking to improve my overall appearance and have reached out to you because of your experience in both aesthetic and reconstructive plastic surgery. Your name was also mentioned in a report by Advance Medical as an expert in this area.
At the time, you had requested a CT scan of the face, which I did not have–but now have one. I have attached photos, 3D reconstructed CT scan, and a brief medical history for your review. The goals of surgery are:
– Improve symmetry of the face, especially involving the eye. This includes the buldging of the eye ball itself, and position of the lid. I fully realize that a full restoration of symmetry is not possible and that surgery on the opposite eye may be necessary to get the most aesthetically pleasing result.
– Reduce the appearance of the port wine stain on the left side of face, near the eye
– Reduce the appearance of the scar on left cheek
– Improve overall appearance, ie. what procedures could be done in combination to ENHANCE overall appearance. Would a strong chin/jaw divert attention from eyes? Would other facial implants help? Would removing the nose bump? (This is why I value your experience in aesthetic plastic surgery)
I know you are very busy and I appreciate you taking a preliminary look at this case for consult.
A: Thank you for sending your pictures and 3D CT scans. What they show is that despite an excellent anatomic reduction of the fractured zygomatico-orbital bones (and an infraorbital-malar implant) your face is not normalied. The problem now, and is a quite common one after facial trauma and multiple reconstructive surgeries, is that the original injured tissues have become ‘skeletonized’. There has been loss of subcutaneous fat with scar tissue that has caused lower eyelid scar contraction as well as the lower facial scar prominence. I think that the left eye does not really bulge but that the lower eyelid is vertically short and contracted, exposing more sclera in that eye.
From a reconstructive standpoint focusing on the original injured tissues, I would recommend the following:
- Lower Eyelid Reconstruction with Dermal-fat Graft and Lateral Canthoplasty (your prior canthopexy was insufficient)
- Left Geometric Facial Scar Revision (your prior laser resurfacing probably made little difference)
- Injection Fat Grafting to Left Cheek and Infraorbital areas (the tissues don’t need suspending, they need more volume.
From an aesthetic standpoint, I would need more pictures for better assessment for both rhinoplasty and jawline enhancement.
Dr. Barry Eppley
Published in 2003 with co-authors Dr. Peter Ward-Booth (United Kingdom) and Dr. Rainer Schmelzeisen (Germany), Dr. Eppley co-authored this now classic textbook entitled Maxillofacial Trauma and Esthetic Reconstruction. In a single volume, the comprehensive topic of the management of bone and soft tissue injuries to the face was done in just over 650 pages with 33 chapters and more than 500 color illustrations.
Bone and soft tissue facial trauma is one of the three major areas in the field of maxillofacial surgery. Having its origins in World War I and II from the last century where many facial injuries occurred, the need for specialized surgery methods for facial reconstruction began. It has now evolved into very sophisticated technologies for bone fixation and movement (plates and screws) as well as replacement of missing soft tissues. (pedicled and free flap transfers) The ‘high-rent’ district of the face allows the need for numerous medical specialities to participate including ophthalmology, neurosurgery, radiology, and dentistry in addition to the classic three surgical specialities of maxillofacial, plastic and otolaryngologic surgery. This book does an excellent job of bringing the knowledge base of all such disciplines together in a single concise volume.
One of the real strong points and emphasis in the book is what most facial trauma books historically lack, reconstruction of secondary facial defects. Despite the best surgical techniques and equipment, not all facial trauma patients end up with perfect results. Beyond simple lacerations and isolated bone fractures, the injury pattern of many facial trauma patients is complex and the best outcome will usually defy a single surgical effort. From scar revisions to occlusal discrepancies to soft tissue deficiences, secondary reconstruction of facial trauma is not rare and the book spends about as much time on those topics as that of primary repair.
This book is now undergoing a 2nd edition which should be forthcoming in the fall of 2011.