Reconstructive Surgery of Facial Defects at Wake Forest Baptist
Facial defects most commonly result from skin cancer removal, but a variety of conditions such as trauma can also result in loss of soft tissue of the face. These defects are corrected with either:
- A geometric rearrangement of the surrounding skin and soft tissue or;
- A skin graft, where skin is transferred from one body part to another
Occasionally, underlying support will need to be restored to a structure in addition to replacing the skin covering. This support most commonly comes from cartilage, which is harvested from one part of the body and moved to the head and neck region.
The nose can be the most complex and challenging site to reconstruct. Its three-dimensional nature and need for structural support often requires need for reconstructive surgery in layers or stages to ensure the best functional and cosmetic result. Frequently, it will be necessary to harvest cartilage from the ear or rib to use for support of the nasal airway in nasal reconstruction. Not only should the reconstructed nose have appropriate contour, but it should also function well and allow for sufficient airflow.
Lip Reconstructive Surgery
The lip also presents several reconstructive surgery challenges. The mouth serves as the anchor of the lower face, and the upper and lower lips form a seal to allow for functions like eating and speaking. In addition, animation (facial movement) conveys nonverbal cues that aid in communication. Lip defects, whether from trauma or skin cancer, should be reconstructed in such a way as to restore function and maximize appearance.
Ear Reconstructive Surgery
Because of its prominent position as an exposed and protruding structure on the side of the head, the ear is a common site for skin cancers. The ear can also be malformed at birth – a condition called microtia. These congenital defects can also be associated with hearing loss. An abnormality of one ear is often quite obvious as the symmetry between the two ears is disturbed. The skin of the ear is thin and is tightly adherent to the cartilage beneath it, and depending on the defect, reconstructive surgery efforts for the ear can center around replacing both skin and/or cartilage.
Eyelid Reconstructive Surgery
The eyelids frame the eyes and facilitate tear film transfer across the cornea, protecting the eye from getting too dry. As with the ears, because the eyelids are a bilateral structure, a defect of one eyelid disrupts not only function but also symmetry. Eyelid reconstructive efforts usually involve geometric rearrangements of surrounding skin. Special attention is given to the support function of the lower eyelids.
Scalp Reconstructive Surgery
The scalp is thick and has a rich blood supply. It is a common site for skin cancers, and it can be injured in cases of head trauma. Scalp defects also frequently involve hair-bearing skin, so hair growth patterns must be taken into consideration when these defects are repaired.
Scar Revision Reconstructive Surgery
As facial skin and soft tissue injuries heal, they can sometimes leave behind unsightly scars. Scar revision reconstructive surgery involves geometric rearrangement of surrounding skin to maximally camouflage scars and restore more normal contour and symmetry to the face. These procedures can often be done under local anesthesia or light sedation on an outpatient basis. We always caution patients to protect scars from significant sun exposure, which can cause them to darken and become more visible.