Plastic & Reconstructive Surgery
Reconstructive surgery is an option that many patients undergoing a parotid tumor surgery explore. Patients with benign tumors may be candidates for facial rejuvenation procedures in combination with their parotid surgery. Standard parotid surgery often leaves patients with facial irregularities secondary to skin expansion and stretching caused by the growing tumor. After tumor removal, the soft tissues of the cheek and overlying skin may be sagging, lax, and redundant,and may require sculpting to successfully reconstruct this facial area.
Our philosophy is simple: perform a sound tumor operation, prevent short and long-term complications, and maintain or improve your facial aesthetic appearance after surgery. This is accomplished by taking a comprehensive approach to your surgery, which involves two teams working simultaneously. Before all procedures, Dr. Hamilton (plastic surgeon) and Dr. Osborne (oncologic surgeon) have a conference to plan your surgery. Incisions, tumor removal, and reconstructive options are discussed for every patient before surgery is performed. The pre-operative conference allows the doctors to account for individual differences between cases, which leads to a customized plan for each patient. Dr. Hamilton and Dr. Osborne then work hand-in-hand throughout your entire operation to achieve the best results possible.
What can be done to prevent a sunken appearance in my face after surgery?
Surgery performed at outside institution without reconstruction.
Immediate reconstruction after parotid tumor removal by Dr. Hamilton.
Problem : The parotid gland supports a large portion of the cheek and upper jaw line in front of the ear. When the parotid gland is removed significant support to the cheek and jawline is lost. The skin tends to sag along the jawline and the cheek takes on a sunken appearance.
Solution: Parotid surgery often leaves patients with facial irregularities secondary to skin expansion and stretching caused by the growing tumor. After tumor removal, the soft tissues of the cheek and overlying skin may be saggy, lax, and redundant, requiring sculpting, to successfully reconstruct this facial area. This laxity may be more pronounced in aging women and men, or patients with larger tumors. Nearly all our patients ask for this saggy skin to be re-contoured and tightened during closure. This always provides the best cosmetic outcome. To improve overall harmony to the face many patients request that the opposite (non-tumor side) be tightened at the same time. Other patients find it beneficial, while under anesthesia, to combine other procedures with their primary surgery to comprehensively enhance their facial appearance. Dr. Hamilton has dual training in head and neck surgery as well as facial plastic and reconstructive surgery making it possible, when appropriate, to restore form and function while simultaneously improving one’s appearance. The best time to perform plastic and reconstructive procedures for any patient undergoing parotid surgery is at the time of there initially surgery. Immediate reconstruction offers several advantages over secondary (or late) reconstruction. There is less risk of injury to the facial nerve during the initially surgery. The patient only requires one anesthetic.
Bipedicled Sternocleidomastoid (SCM) Muscle Flap
How will my cheek be repaired?
Problem: Removal of parotid tumors requires the surgeon to remove a margin of normal parotid tissue around the tumor to prevent regrowth. Unfortunately, this results in an increase in the volume of tissue removed from the face, leaving a sunken appearance.
Solution: We use a unique muscle flap to reconstruct the parotid defect called a bipedicled sternocleidomastoid (SCM) muscle flap. The Bipedicled SCM Muscle Flap was specifically designed to fill in the facial defect left behind after parotid tumor surgery and has several advantages over conventional SCM muscle flaps. Because of the strength and size of this neck muscle we are able to effectively restore facial symmetry and maintain facial fullness after parotid surgery.
Is it true my cheek defect can be repaired using my fat or cadaver grafts?
Fat can be effective for filling defects after parotid surgery but it is not our choice of graft material for several reasons. First, fat must be harvested from the abdomen in a large solid block of tissue to survive the transfer to an open wound in the face. This requires an additional abdominal incision to remove the fat effectively adding two surgery sites to the case. We avoid fat transfer because all materials needed to reconstruct the face are available at the initial site of surgery, we do not want patients to have two surgery sites. Fat transfer by liposuction is not possible during the primary surgery because the implanted fat is not likely to survive. Dying fat cells liquefy and increase the risks of post-surgical fluid collections, infections, facial scaring, and facial asymmetry.
Cadaveric grafts such as Alloderm can be used for correction of parotid defects but require additional cost and introduce foreign materials to the patient’s body. Although Alloderm and other bovine and cadaveric grafts have been shown safe for human implantation, we have found that in the majority of cases they are unnecessary and are not required for a satisfactory reconstruction.
I have a facial weakness and a droop associated with my parotid. What are my options?
Facial weakness and asymmetry are improved by a combination of non-invasive and minor procedures performed at the same time as your parotid surgery. Noninvasive treatments include well known products such as botox and facial fillers which work to improve motor dysfunction and enhance facial symmetry. Other minor surgical procedures may also be required to further augment facial symmetry such as mini brow/forehead lifts, upper and lower lid blepharoplasty, with or without gold weight placement, rhytidectomy (facelift), and static or dynamic facial slings. Globally these procedures are termed as Facial Reanimation Procedures because they serve to bring harmony to the patient’s face. The case presentation shows an example of a combination of the procedures used to improve facial weakness for this patient.
Case presentation: This gentleman had a parotid tumor and suffered from right facial nerve weakness involving the right forehead, brow and eyelid complex. He underwent a right-sided browlift and bilateral upperlid blepharoplasty to improve his symmetry to the face. These procedures were performed simultaneously with parotid and facial reconstructive surgery which allowed the patient to only have one anesthesia and facility stay. Notice improved facial symmetry between the brows and upper eyelids.
Non-Surgical Correction of Facial Deformity
What can be done if I have already had surgery and have a sunken face?
Advances in facial augmentation with temporary and semi-permanent soft tissue fillers make it possible to improve the appearance of unsightly scars and facial asymmetries without the need for permanent implants or surgery. Candidates for these treatments generally have good facial symmetry with only minor scarring or facial deformities. Patients who have had multiple surgeries and desire less invasive procedures to improve their appearance may also find these treatments appealing. These procedures are performed on an outpatient basis and require little to no down time.
Case Presentation: This gentleman had a prior parotidectomy in New York which left a sunken deformity under the left ear and along the jaw line. The patient was told that this defect could not be fixed. The defect was corrected by Dr. Hamilton by placing a small amount of injectable filler material in the area of the deformity. This is the patient’s immediate result after a simple 20 minute procedure. Notice how the patient’s jaw line is restored and the sunken appearance in improved.