At Westlake Dermatology & Cosmetic Surgery, we offer a full range of reconstructive facial plastic surgery options to correct congenital, malignant, traumatic or post-surgical defects and deformities. Our team of experienced plastic and facial plastic surgeons balances aesthetics with technical knowledge to correct tissue and structural problems; recreating a natural appearance and improving functionality.
Common facial reconstruction surgery procedures include orbital reconstruction, midface or zygoma fracture, facial nerve paralysis surgery, ptosis correction, Mohs surgery closure, and laceration repair.
Orbital Fracture Repair Surgery (Orbital Reconstruction)
The orbit (commonly referred to as the eye socket) is a bony enclosure that houses the eye along with all corresponding tissue and nerves. If the orbit becomes severely fractured (most commonly from blunt force trauma from a car accident, fall or altercation) individuals can experience a variety of issues including severe pain, swelling, vision issues, and infection. Additionally the area can suffer negative aesthetic results such as eye drooping.
Orbital fracture surgery can be performed to repair the orbit, restoring functionality of the eye and providing a natural appearance. During the procedure, a surgeon extracts entrapped soft tissue and repositions fractured bone fragments to provide enhanced structural integrity of the socket. Sometimes a titanium or porous implant is used to reconstruct the orbital floor blow out fracture.
Midface/ Zygoma Fracture
A Lefort fracture (midface fracture) is an underlying structural fracture of the midface stemming from a major trauma. The underlying structure of the midface is extremely complex, with a “tent-like” bone structure covered by overlying soft tissue. However various surgical techniques utilizing titanium plates enable the area to be restored.
A zygoma fracture causes the cheek bone to be displaced into the face, causing flattening of the cheek. It can compress the nerve that provides sensation to the cheek, causing numbness to the cheek, nose and upper lip. The fracture often also involves the orbit (see Orbital Fracture above) and cheek (maxillary) sinus. Repair of this fracture involves using titanium plates to recreate stability after the bones are repositioned into their correct locations.
Facial Nerve Paralysis (facial reanimation surgery)
Facial nerve paralysis limits basic functionality to specific areas of the face, most notably the mouth, forehead, and eyes. Paralysis stems from damage to the facial nerve. Facial nerve paralysis can be caused by infection, trauma, tumors, stroke, autoimmune disorders, and Bells Paly disease. It can range from mild to severe.
Facial reanimation surgery can be performed to correct appearance deformity caused by facial paralysis. Various techniques can be used to restore movement and facial symmetry:
Facelift surgery is not just for cosmetic improvement for the aging face. After facial nerve paralysis, the paralyzed side lacks the muscular support to hold the face up. As a result it sags, creating a distortion between the strong and the weak sides of the face. Facelift surgery can re-support the sagging side to create better symmetry. Jowls and the midface can be elevated and strengthened, resulting in correction of the asymmetry.
Just as the face sags on the paralyzed side, so does the eyebrow and upper eyelid. In addition, the muscles that close the eye are weak, so the eyelid does not close well while the weight of the eyebrow creates a heavy look. This condition is called lagophthalmos.
Blepharoplasty surgery can correct all these issues. Combinations of different forehead lift techniques (direct brow lift, hairline brow lift or endoscopic forehead lift) can be used to elevate the affected eyebrow while also improving the unaffected side if needed. Upper eyelid closure can be enhanced and lagophthalmos corrected by placing a small gold weight into the upper eyelid to help it close. This protects the eye during sleep and improves the blink so the eye is less dry and the cornea is better protected against corneal abrasions or ulcerations.
Lower Eyelid Canthal Tightening
The lower eyelid will often sag after facial paralysis. The lower eyelid is vital in pumping tears across the cornea to keep it moist. When it sags, tears cannot be pumped and the cornea can become dry or ulcerated. Lower eyelid lateral canthal tightening surgery (canthoplasty or canthopexy) will tighten the lower eyelid, improving its pumping action and tear lubrication of the cornea.
When weakness is severe, a midface lift is performed at the same time as lower eyelid tightening. The midface lift elevates the tissues that support the lower eyelid, lifting and tightening it further.
After facial paralysis, when the face sags it can also appear as if it loses volume. Fat transfer, where fat is harvested elsewhere in the body and then transferred to areas of poor facial volume, is a great way to restore proper facial proportion. Ptosis (droopy eyelid).
Ptosis is the drooping of the upper eyelid. In addition to affecting an individual’s aesthetic appearance, ptosis that is severe or remains untreated can lead to other conditions, such as amblyopia (“lazy eye”) or astigmatism. This is why it is especially important for this disorder to be treated in children at a young age, before it can interfere with vision development.
Reconstructive surgery is typically the most effective treatment for ptosis. During surgery, a physician tightens the levator muscles in order to lift the eyelids, enhancing both the vision and appearance of the eyes.
Mohs/Cancer Surgery Closure
Depending on the size of the malignant lesion that is removed during a Mohs surgery procedure, some patients may be left with a depression or hole in the skin. Mohs surgery closure can be performed immediately after Mohs surgery to repair the damaged site and limit scarring.
Mohs surgery closure typically utilizes healthy skin flaps or grafts taken from an area adjacent to the wound in order to reconstruct facial tissue. In severe cases, tissue, cartilage or bone from other parts of the body may be used. Nasolabial flaps, cheek advancement flaps, and forehead flaps are some of the flaps that can be used to restore a natural face appearance by matching the best texture, color and contour for the missing tissue.
The facial skin is very delicate and extremely susceptible to developing unsightly, permanent scars from moderate to severe cuts and lacerations. While many ER providers can close a laceration with stitches, quickly treating facial lacerations can result in unwanted permanent scarring.
An experienced reconstructive surgeon utilizes advanced facial skin laceration repair techniques to minimize the potential for scarring. Careful re-approximation of the injured layers of tissue can help to minimize the visible scar.
As the scar heals, sometimes color, texture and contour make it more apparent than ideal. Our reconstructive plastic surgeons will monitor the scar during the critical healing periods and can intervene to make the scar heal more ideally. Some interventions can include injecting the scar with steroids or fluorouracil, using lasers to improve color and texture, and utilizing dermabrasion for severe contour step-offs.
Even once a scar has fully healed, it can be improved further. Scar revision plastic surgery using W-plasty, Z-plasty or geometric broken line closure (GBLC) can improve fully healed scars by changing the way the eye detects the scar. Depressed scars can be improved by performing fat transfer or other filler procedures to elevate the base of the scar and improve its contour.