Case Studies Facial Reconstruction

  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is former professional tennis player and golfer in her mid 50’s who presented with an extensive Squamous Cell Cancer of her lower lip.

Assessment

The patient had Mohs micrographic surgery performed by my dermatology colleague in our office and now presents with loss of her entire red lower lip and the adjacent skin below her lip.

Procedures

Under local anesthesia supplemented with oral valium, in our office, the patient underwent  extensive mucosal and cutaneous (skin) advancement flaps. After 6 weeks of healing, the patient started a stretching  regime specified by our office for all lip reconstruction  patients to regain lip suppleness and mobility. The patient is shown 6 months after surgery.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a man in his early 20’s who was involved in a motor vehicle accident and suffered a severe crush injury to his frontal skull. He underwent 2 previous attempts at reconstruction involving multiple surgical procedures at an outside hospital which failed. He presented to our office the day he left the other hospital seeking corrective surgical treatment.

Assessment

The initial assessment was remarkable for a complete absence of the skull in the area of the defect with the pulsations of the brain easily palpable. The patient had an intact neurological examination, was pleasant and had excellent recall of the recent events except the accident itself, for which he had no recall. He was otherwise healthy and well nourished.

Procedures

The patient had a multi-step surgical reconstruction, the steps of which are detailed in the photographs above. The first photo shows the patient at his initial office visit. The second photo shows the patient 5 weeks after he underwent posterior scalp expansion with a surgically placed expander which was filled with saline twice a week to stretch the skin envelope. The third photo shows the 3-dimensional model generated from a CT scan to design  a customized acrylic implant to replace the absent skull bone. The fourth image shows the patient 6 months after the surgical procedure to place the skull implant, The final set of images is the patient shown in 3/4 view before and 6 months after the final surgical procedure.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a man in his mid 70’s who presented with an extensive Basal Cell Cancer of his nose.

Assessment

The patient had Mohs micrographic surgery performed by my dermatology colleague in our office and now presents with loss of his nasal tip skin and a total full thickness loss of his right nostril and sidewall with exposure of his nasal septum. Note that there is still some surgical packing visible in the pre-operative photos, which was placed by the Mohs surgeon the previous day.

Procedures

Under general anesthesia in a hospital operating room, the patient underwent a forehead flap reconstruction of his external nose and a septal mucosal hinge flap for internal lining (see the photo to the far right which outlines the forehead flap that will become the patients nasal skin envelope). The cartilage structure of his nose was reconstituted with ear cartilage grafts. At a second stage in the office, under local anesthesia, his forehead flap was completed. The third procedure  performed in the office reconstructed his nostril rim with a cheek flap as the forehead flap had contracted and created a suboptimal aesthetic result. The final procedure was the take down and inset of his cheek flap, also in the office under local anesthesia. The patient is shown 4 months after his final surgical procedure.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient is a woman in her mid 50’s who presented with an extensive Basal Cell Cancer of her cheek and lip.

Assessment

The patient had Mohs micrographic surgery performed by my dermatology colleague in our office and now presents with a substantial loss of  her medial cheek, and near total loss of her right upper lip including all of the muscle that creates a circular sphincter enabling normal function and exposed upper teeth.

Procedures

Under local anesthesia supplemented with oral valium, in our office procedure room, the patient underwent a rhombic cheek flap and a lip switch flap known as an Abbe flap. This technique borrows full thickness lip tissue from the lower lip and moves it to the upper lip. The markings for the surgical procedure are shown. After the initial procedure, the patient had a second procedure to complete the transfer of the lower lip to the upper lip. Several months later, the patient had a Z- plasty flap to redirect the right corner of the lip downward to create a more symmetrical lip posture. The patient is shown before the reconstruction and 5 months after her last surgical procedure. Her scars will continue to lighten up to 1 year post- operatively. Like all of our lip reconstruction patients, she was counseled to perform daily stretching exercises. The patient is shown stretching her lip and cheek using a ping pong ball as a  soft tissue expander. This clever idea was developed by the patient herself.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.

  • Before
  • After
  • Before
  • After
  • Before
  • After

*Individual results may vary. Please see full disclaimer.

Chief Complaint

The patient presented as an 11 year-old boy with a right-sided, grade III microtia, which is congenital absence of all the normal external features of the ear. It is commonly referred to as a peanut ear deformity since the severely deformed ear has a peanut-like shape.

Assessment

The patient is a generally healthy boy with an isolated right, grade III microtia. There is complete absence of normal ear architecture except for an identifiable lobule which is folded onto itself and will be usable for the reconstruction. The ear canal is absent.

Procedures

The patient underwent a 2 stage microtia reconstruction, both performed at  Children’s Hospital. The first operation usesd a customized Med-Por framework that  was shaped in the operating room using the patients normal ear as a template.  This is attached to the skull after removing the abnormal ear cartilage structure. The frame work is then wrapped with a vascularized temporal-parietal fascial flap from underneath the hair -bearing skin in the temple area and covered with skin grafts from behind the opposite, normal ear and the abdomen. The second stage performed several months later, reconstructs the tragus (the small, curved structure in front of the ear canal) with cartilage taken from the opposite, normal ear bowl. The patient is shown before and 17 months after his last procedure.

Disclaimer: Individual results will vary and no guarantee is stated or implied by any photo use or any statement on this website. Please see full disclaimer.