Facial Reconstruction Surgery

After Surgical Removal of Cancer

For patients with head and neck cancer, the first type of major surgeries are meant to remove harmful cancerous tissue. This approach may only be about half of a complete care plan for a patient with head and neck cancer.

Further surgery will likely be needed to rebuild the surrounding areas of the face that are visible. Surgical reconstruction may be used to rebuild the tissues of the jaw, skin or tongue.

Surgically removing aggressive cancer can also disrupt the form and function of affected areas in the face. We aim to be just as aggressive in rebuilding those vital head, neck and facial tissues so our patients can return to as close to a normal quality of life as possible.

What types of cancer is it used for?

Microvascular free flap surgery is most often used on cancers that start in the oral cavity.  However, it can also be used when patients have recurrent cancer or other advanced cancers in the head or neck.

Nerve grafts are most commonly used for cancers that involve the facial nerve.

Your head and neck surgical specialist will determine the type of reconstruction will be best for you. 

After Severe Burn Injuries

Surgery is often used to correct defects, deformities or muscular functions that are the result of a trauma or injury, such as a severe burn. 

A third-degree burn can cause severe damage to the skin, muscles and bones of the face. Surgery can be used to repair this damage.

Facial Paralysis

While facial paralysis may be a result of some other injury or condition, it may also be a primary reason to receive a facial reconstruction procedure to restore function to the face.

Correcting birth defects

Surgery can also be used to correct birth defects, such as a cleft lip or cleft palate.

This type of surgery can be performed using a variety of techniques, including skin grafts, tissue expansion, nerve grafts or free-flap surgery. The type of technique used will depend on the specific defect or deformity being corrected.

When cancer or severe burns have destroyed the normal areas of your head or neck that are involved in eating and speaking, an advanced reconstructive surgery may be needed to help restore both form and function of the areas that were impacted by the cancer.

Types of Facial Reconstruction Surgery

Microvascular Free-Flap Surgery

Reconstructive procedures may require a free-flap microvascular surgery technique.

A free flap is a piece of tissue that includes skin, muscle and/or bone that is moved from one part of your body to another. The blood vessels that supply the free flap are removed along with the flap and then reattached to blood vessels at the surgical site.

This type of surgery is often used for larger facial reconstruction procedures, such as those that involve the nose, lips or eye sockets.

Facial Nerve Graft Surgery

Nerve grafts from other parts of your body are also used to reconstruct the face.

Nerve graft surgery is a type of procedure that can be used to improve the function of facial muscles and restore movement to the face. Facial nerve grafting involves the transfer of a healthy nerve from another area of the body to the area with the damaged or injured facial nerve.

This surgical techniques can be used to rebuild facial muscle movement for areas of the face including:

• Jaw

• Tongue

• Sinus

• Palate

• Neck

Skin Grafting

Skin grafting is a type of surgery that involves taking skin from a healthy area of the body and using it to repair an area of the head, neck or face. This type does not involve transplanting the nerves or blood vessels.

Autologous Grafting and Allogeneic Grafting

There are many different types of skin grafting surgery, which can be divided into two main categories: autologous grafting and allogeneic grafting.

Autologous grafting is performed using skin from the same individual, where allogeneic grafting is performed using skin from a donor.

Skin grafting surgery can be performed using a variety of techniques, including split-thickness skin grafting, full-thickness skin grafting and composite grafting. The type of technique used will depend on the specific defect or deformity being corrected.

Split-thickness skin grafting is often used to treat defects of the skin, such as burns or ulcers. Full-thickness skin grafting is often used to treat defects of the soft tissue, such as the lips or cheeks. Composite grafting is often used to treat defects of the bones, such as eye sockets.

Tissue Expansion

Tissue expansion is a type of surgery that is used to treat defects or deformities of the soft tissue. This process can be used to treat defects or deformities of the skin, such as burns or ulcers.

Tissue expansion surgery can be performed using a variety of techniques, including local tissue expansion and remote tissue expansion.

Local tissue expansion is performed using skin from the same individual. Remote tissue expansion is performed using skin from a donor.

How does tissue expansion work?

Tissue expansion surgery works by stretching the skin over some time.

The first step in tissue expansion surgery is to insert an expandable balloon beneath the skin. The balloon is then inflated over a period of time, which stretches the skin.

Once the desired amount of skin has been stretched, the balloon is removed and the excess skin is trimmed away. The resulting skin flap is then used to cover the defect or deformity.

Reconstructive Facial Plastic Surgery

Facial plastic reconstruction is a subspecialty of plastic surgery that can be used to correct or restore form and function. This can be done to repair damage from accidents or disease or to improve the look of a person. This method may be used in combination with the techniques above or if more complex methods are not necessary.

Some common types of facial plastic reconstructive surgery include:

• Craniofacial surgery

• Maxillofacial surgery

• Microsurgery

• Nose surgery (rhinoplasty)

• Neck Surgery

• Facial Fillers

In addition to helping repair the shape and look of the face, advanced reconstructions help you maintain the function of critical structures in your head and neck so that you can continue to eat, drink and swallow.

Reconstructive procedures are more advanced than other types of surgery and are done by surgeons that have received advanced fellowship training in head and neck microvascular surgery. It is best to receive this type of advanced procedure at a center that does them regularly and has the support services necessary to assist you in recovery.

There are certain risks to keep in mind if you are receiving this type of surgery.

Before Surgery

It is important to stop smoking at least two weeks prior to surgery. Nicotine products raise  risk for complications after surgery and risk poor wound healing.

Please make sure to bring a friend or family member with you to any appointments discussing surgery.

After Surgery

To avoid complications it is important to follow your provider’s instructions for recovery.

Advanced reconstructive surgery requires close monitoring in the hospital setting so that your doctor can keep a close watch on the areas you had surgery. They will use a special machine to make sure that the free flap has enough blood flowing to the tissue. You may have one or more drains to help keep fluid from collecting under your skin after surgery.  

You are likely to have one or more scars after surgery.

Depending on where your cancer is, you may need a temporary breathing tube and temporary feeding tube to use while your incisions heal. Your doctor will provide you with information regarding these devices if they are necessary for your treatment.

How long does facial reconstruction take?

Facial reconstruction surgery can take anywhere from a few hours to several days, depending on the extent of the procedure.

Is facial reconstruction painful?

Facial reconstruction surgery is generally performed under general anesthesia, which means that you will be asleep during the procedure. You may experience some pain and discomfort after the surgery, but this can be managed with medication.

How long does it take to recover from reconstructive surgery?

The recovery time for facial reconstruction surgery can vary depending on the extent of the procedure. However, most people can expect to take at least a few weeks off from work or other activities to recover.

How long does facial swelling last?

Facial swelling is a common side effect of facial reconstruction surgery. This can last for several weeks after the surgery. It will be helpful to manage the swelling with anti-inflammatory medications.

How reliable is facial reconstruction?

Facial reconstruction surgery is generally considered to be safe and reliable. However, as with any type of surgery, there are always risks involved especially with more severe injuries or causes. You can lower the risks by seeking treatment with highly experienced, fellowship-trained specialists like those at the Head and Neck Cancer Center.