The First Time I … Repaired a Facial Cleft
Dr. David Matthews
Plastic Surgeon, David Matthews Cosmetic and Reconstructive Surgery
A physician I knew in Chapel Hill called me to do a cleft for a four-year-old boy with a Tessier cleft number 4, a cleft that ran through the arch of his upper jaw into the palate, up alongside his nose, and into the orbital cavity. They had actually tried to close it before, but it had already fallen apart.
I talked with the boy's parents before the procedure, and they wanted to know how we could help him, if we could make him look normal. The answer was that we could make him look more normal, but never completely. There's a significant amount of facial deformity that can't be totally corrected, but you do the best you can to give them a normal life back.
We tried to reconstruct normal facial landmarks with tissue. First, we had to partition normal spaces, making sure the orbital cavity (where your eye is) was separate from his sinus was, and that his sinus cavity was separate from the oral cavity, so that food wouldn't come into his nose. Then, we did a bone graft from his skull to form bone structure in his face. A tissue expander went into his cheeks so the scar tissue could move over next to his nose, where the scars would be less conspicuous.
I saw him immediately after, but haven't seen him since then. He'd likely have needed surgery again at age nine or ten, to continue building symmetry in his face after he had grown more.
He was young enough at the time that psychological effects and issues at school hadn't come up yet, but I talked with his parents about dealing with these problems when they came up. With these children, you're constantly working to build their self-esteem, and empower them to handle these issues rationally and sensibly. —As told to Annie Monjar
Counterintuitive Cosmetics In the United States in 2008:
- Breast augmentation decreased by 12 Percent, but pectoral implants increased 203 Percent
- Face-lifts decreased 5 Percent, but buttock lifts increased 8 Percent
- Chin augmentations decreased 5 Percent, but cheek implants increased 11 Percent
- Calf augmentation decreased 25 Percent, but lower body lifts increased 8 Percent
- Cosmetic procedures among Caucasians decreased 2 Percent, but increased 5 Percent among asians, 10 Percent among african americans, and 18 Percent among hispanics
Source: The American Society of Plastic Surgeons