Congenital Correction Common Procedures

Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.

Cleft Lip Repair (Cheiloplasty)

Cleft lip repair is one of the most common congenital surgeries. The procedure reconstructs the upper lip to restore muscle continuity and create a natural appearance. It involves precise rearrangement of tissue to close the gap, align the lip border (vermilion), and reconstruct the nasal floor.

The surgery typically occurs when the infant is around three months old, following the rule of tens (10 weeks old, 10 pounds in weight, and hemoglobin of 10). The surgeon dissects the orbicularis oris muscle and sutures it to create a functional sphincter for the mouth, which is vital for feeding and speech.

• Realignment of the white roll and vermilion border
• Reconstruction of the orbicularis oris muscle sphincter
• Correction of nasal asymmetry and nostril shape
• Lengthening of the lip to match the unaffected side
• Minimization of scar visibility within natural contours

Cleft Palate Repair (Palatoplasty)

Palatoplasty addresses the cleft in the roof of the mouth. The goal is to separate the oral and nasal cavities to enable normal swallowing and speech production. This surgery is usually performed between 9 and 12 months of age, before the child begins to produce significant speech sounds.

Surgeons mobilize the tissues of the complex and soft palate to close the defect without tension. A critical part of the procedure is the reconstruction of the levator veli palatini muscles, which lift the soft palate to close off the nose during speech (velopharyngeal competence).

• Closure of the communication between the nose and the mouth
• Reconstruction of the soft palate musculature
• Lengthening of the palate for speech function
• Preservation of vascular supply to palatal flaps
• Prevention of future fistula formation

Microtia Reconstruction

Microtia reconstruction creates an external ear for children born with absent or underdeveloped ears. There are two main approaches: autologous reconstruction using the patient’s own rib cartilage and alloplastic reconstruction using a porous polyethylene implant.

In the autologous method, cartilage is harvested from the child’s ribs, carved into the shape of an ear framework, and implanted under the skin of the scalp. This is typically done in stages, starting around age 6 to 10, when the rib cage is sufficiently developed. The result is living tissue that grows with the child.

• Harvesting and carving of costal cartilage
• Creation of a 3D ear framework
• Implantation beneath the mastoid skin
• Elevation of the ear in subsequent stages
• Creation of the earlobe and tragus

Syndactyly Release

Syndactyly release separates fused fingers or toes. The goal is to provide independent movement and function to each digit. This surgery is usually performed between 12 and 18 months of age to prevent tethering from affecting finger growth.

The procedure involves complex zigzag incisions to prevent scar contracture. Skin grafts, often taken from the groin area, are frequently needed to cover the raw surfaces on the sides of the separated fingers. Care is taken to reconstruct the web space between the fingers for a natural appearance.

• Separation of fused bony or soft tissue connections
• Design of zigzag incisions to prevent straight-line scars
• Reconstruction of the interdigital web space
• Application of full-thickness skin grafts
• Preservation of the neurovascular bundles to each finger

Polydactyly Correction

Polydactyly correction involves removing extra digits on the hands or feet. The complexity varies from tying off a small skin tag to complex reconstruction involving shared bones and joints. The goal is a hand or foot with five functional digits and a normal contour.

For the hand, surgery is often done around 1 year of age to minimize the impact on hand function development. The surgeon must carefully reconstruct the remaining digit's ligaments and tendons to ensure stability and range of motion.

• Excision of supernumerary digits
• Reconstruction of collateral ligaments
• Realignment of tendons and bones
• Narrowing of the hand or foot width
• Optimizing the aesthetic contour of the remaining digit

Craniosynostosis Release

Correction of craniosynostosis involves reshaping the skull to allow the brain to grow and correct head-shape abnormalities. This is often a multidisciplinary procedure involving a neurosurgeon and a plastic surgeon. The fused sutures are released, and the skull bones are remodeled.

Techniques range from minimally invasive endoscopic strip craniectomy (often followed by helmet therapy) for young infants to open cranial vault remodeling for older children. The goal is to normalize intracranial pressure and restore a symmetrical forehead and brow appearance.

• Release of prematurely fused cranial sutures
• Remodeling of the frontal and orbital bones
• Expansion of the cranial vault volume
• advancement of the forehead for symmetry
• Utilization of resorbable fixation plates

Otoplasty

Otoplasty, or ear pinning, corrects prominent ears that stick out far from the head. While often considered cosmetic, in the context of congenital deformities, it addresses absent antihelical folds or deep conchal bowls. It is typically performed after age 5 when the ear cartilage has stabilized.

The surgeon makes an incision behind the ear to reshape the cartilage, creating the missing folds and setting the ear closer to the head. This procedure can have a profound impact on a child’s psychosocial well-being by preventing teasing and bullying.

• Correction of protruded or prominent ears
• Creation of the antihelical fold
• Reduction of the conchal bowl depth
• Setback of the ear closer to the mastoid
• Symmetry adjustment between both ears

Treatment of Vascular Anomalies

Treatment for vascular anomalies depends on the type. Infantile hemangiomas are often treated medically with beta blockers, but surgical excision is performed for those that ulcerate, obstruct vision, or leave residual fibrofatty tissue or scarring after regression.

Vascular malformations (venous, lymphatic, AVMs) do not regress and may require sclerotherapy (injection of scarring agents) or surgical debulking. Surgery focuses on removing the abnormal vessels while preserving nerves and muscles, often requiring a staged approach due to the infiltrative nature of these lesions.

• Surgical excision of residual hemangioma tissue
• Debulking of lymphatic malformations
• Sclerotherapy for venous malformations
• Laser therapy for port wine stains
• Complex reconstruction after mass removal

Tissue Expansion

Tissue expansion is a technique used to grow extra skin for reconstruction. It is commonly used to remove large congenital nevi (moles) or to reconstruct the scalp. A silicone balloon is surgically placed under the skin and gradually filled with saline over weeks or months.

This process stretches the skin, stimulating new cell growth. Once enough new skin is generated, the expander is removed, the lesion is excised, and the new skin is advanced to cover the defect. This provides skin with a perfect color and texture match.

• Implantation of sub-dermal silicone expanders
• Gradual inflation to stimulate skin growth
• Excision of large congenital lesions
• Advancement of expanded skin flaps
• Reconstruction with matching hair-bearing tissue

Orthognathic Surgery

Orthognathic surgery corrects jaw discrepancies associated with conditions like cleft lip and palate or hemifacial microsomia. It involves cutting and repositioning the upper jaw (maxilla) and lower jaw (mandible) to align the bite and improve facial proportions.

This is typically performed in late adolescence when skeletal growth is complete. It improves chewing function, speech resonance, and airway patency, in addition to dramatically enhancing facial aesthetics.

• Le Fort osteotomies for maxillary advancement
• Mandibular sagittal split osteotomies
• Correction of malocclusion and bite alignment
• Improvement of facial profile and symmetry
• Enhancement of the airway space