Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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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.
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).
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.
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.
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.
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.
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.
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.
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.
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.
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The Rule of Tens is a guideline for determining when an infant is ready for cleft lip surgery. It suggests the baby should be at least 10 weeks old, weigh 10 pounds, and have a hemoglobin level of 10g/dL to ensure safety during anesthesia.
Autologous rib cartilage reconstruction typically requires two to four surgical stages spaced several months apart. The first stage creates the framework, and subsequent stages refine the ear and its details, such as the earlobe.
When performed correctly by a hand specialist, amputation of excess digits improves hand function. The surgery not only removes the extra finger but also reconstructs the ligaments and muscles of the remaining finger to ensure it is stable and mobile.
Recovery involves a specialized diet to protect the surgical site. Children are typically on a liquid or soft diet for several weeks and may need to wear arm restraints (no sleeves) to prevent them from putting objects in their mouth that could damage the repair.
No. Many infantile hemangiomas shrink on their own over several years. Surgery is reserved for those who cause functional problems (like blocking vision), bleed frequently, or leave behind significant scarred or fatty tissue after shrinking.
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