Plastic Surgery: Some Facial Reconstructive Surgeries

Plastic surgery is divided into two separate kinds of surgery: cosmetic surgery and reconstructive surgery. Cosmetic surgery reshapes normal structures of the body in order to improve the patient’s appearance and self-esteem. Examples would include face-lifts, breast augmentations, tummy tucks. It is not covered by health insurance. Reconstructive plastic surgery is applied to congenital deformities (birth defects) and the results of accidents, infection, and disease. Although appearance may be enhanced, the main goal of surgery is to restore function. Reconstructive plastic surgery is usually covered by insurance.

Resonctructive plastic surgery was spurred on by the aftermath of WWI. It developed in England and spread from there. The main advances were the creation of flap surgery-moving tissues from one area to another with intact blood supply. Plastic surgery can now connect blood vessels as small as 1 to 2 mm in diameter. In microvascular free flap a section of tissue and skin is detached from its original site and re-attached to the new site by hooking up all the tiny blood vessels. A microscope is required for this delicate surgery.

This article focuses on reconstructive plastic surgery of the face and gives just a taste of the range of possible surgeries.

A condition called Bell’s palsy affects the face. Bell’s palsy is not a disease but a condition that sometimes results from infection or virus. Often it is goes away on its own but sometimes it is permanent and impairs speech, the patient’s eyelids can’t close completely, there is drooling, and facial features droop. The plastic surgeon will graft nerves from other parts of the body into the face. The surgeon may also implant small tubes in the face to regrow nerves. Eyelids may require weights or springs and muscle spasms may require surgical division of overactive muscles. Thus reconstructive plastic surgery can do a great deal to improve the lives of people with Bell’s palsy.

In 2004 in Philadelphia, plastic surgeons stretched a whole piece of skin from the patient’s back by inserting a balloon like device and gradually filling it with salt water over time. Then one piece of stretched skin was removed from the back and used in a microvascular transfer. The flap was big enough to allow surgeons to construct a nose, thus eliminating the need for a separate surgery. This surgery was groundbreaking because previous reconstructive surgeries on the face have involved transplanting very thin slices of skin over many surgeries.

Dr. Maria Siemionow is going to do something even more daring. She has been frustrated by the results of conventional plastic surgery on people whose faces have undergone severe trauma with loss of normal facial functions including the inability to convey even the most basic of emotional expression such as a smile. Even after dozens of surgeries, these patients must feed themselves through tubes and they are so disfigured that they become homebound and chronically depressed.

Sometime in 2005, Dr. Siemionow plans to do a face transplant. She will remove a face from a cadaver along with its underlying fat and blood vessels but not the muscles. Teams of surgeons will rotate over a surgery expected to last 15 hours or longer.

This raises some very interesting questions about identity and some people are opposed to face transplants but it has been pointed out that they are not the people with severely disfigured, non-functional faces.

A highly controversial plastic surgery is that done on the faces of children with Down syndrome. This surgery is major and extensive; it includes resection of the tongue, correction of the down turned lower lip, lifting the nasal bridge, placing implants in the cheeks, and removing the extra folds at the eyes.

Proponents of this surgery argue that the appearance of a child with Down syndrome makes him or her the victim of teasing and shunning which would not happen if the child had a more “normal” appearance. Opponents say that the problem is not the appearance of the child, but social prejudice, which can be overcome once people get to know the child. They say the problem is also the inability of the parents to accept a child with a disability. They argue that a child should not needlessly be subjected to the pain and trauma of one or more major surgeries.

Several studies have shown that parents are happy with the results of the plastic surgery, although one study showed that independent raters could find no improvement in appearance. Many, many studies demonstrate there is no change in social functioning.

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