Restoring severely disfigured faces.

Three-dimensional imaging, Doppler monitoring, microsurgical techniques, and camouflage makeup can be combined to reconstruct faces that have been severely disfigured by burns, trauma, or congenital birth defects. Multi-stage reconstruction uses microvascular free-tissue transfer to replace entire aesthetic units of the face, such as the cheek, neck, nose, lips, or ears. For more than a decade, microvascular flap techniques have been used successfully in breast surgery, neurosurgery, and other surgical subspecialties, but the technique has been underutilized in facial reconstruction.

"Most of my extensively burned patients are in their teens or twenties with five to six decades of productivity ahead of them," indicates plastic surgeon Elliott H. Rose, affiliated with the Mount Sinai Medical Center, New York City. "This newly refined surgical procedure, known as aesthetic facial restoration, allows them to regain a normal appearance, reintegrate into society, and have fulfilling lives."

More commonly, skin grafts have been used to reconstruct facial disfigurement. However, grafts often produce skin that is hard and rigid with a corrugated, thick surface texture. The procedure frequently masks facial animation, leaving an expressionless look.

In a study conducted over a period of eight years, multi-stage reconstruction was performed on 18 burn patients with severely disfigured faces. Among the facial areas reconstructed were neck, chin and lower lip, jaw, cheek, nose, upper lip, ear, forehead, and scalp, as well as the periorbital area around the eyes.

Before surgery, high-resolution video imaging was used to plan the procedure and project the desired surgical outcome. Specialized software was used to diagnose and re-create any bone or soft tissue abnormalities and assess the symmetry of the face. A...