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Plastic Surgery

Our Expertise

Our plastic and reconstructive surgery capabilities focus on:

• congenital and acquired deformities of the skull, face, and the orbit of the eye, which consists of the eye sockets and other structures that support the eyes
• giant nevi and other skin lesions
• vascular malformations
• cleft lip and palate deformities
• deformities resulting from cancer surgery or treatment
• injuries and trauma-related deformities
• burns

Our plastic surgeons are trained in the full range of reconstructive procedures, including craniofacial surgery, hand surgery for congenital hand deformities in which there are too many digits or where digits are fused together, and microsurgery capabilities when that expertise will improve the outcome.

In children in whom craniosynostoses cause irregularities in the shape of the skull or facial features, our plastic surgeons, in collaboration with other members of the craniofacial treatment team, can shift bones of the head and face into natural positions in a gradual, stepwise manner through the technique known as distraction osteogenesis, providing these children with a more normal appearance.

Our plastic surgeons use a combination of the latest techniques and operative approaches and suturing with fine instruments to minimize scarring when removing hemangiomas, brown spots or other lesions. These may include skin grafting, serial excisions that may involve a purse string technique to remove a hemangioma followed by a second technique to reduce the skin further, or a tissue expansion technique to promote the growth of normal skin tissue into the area of the birthmark.

With vascular malformations, in which blood vessels have distorted paths or structures, the craniofacial and plastic surgeons work with other specialists on the team, such as interventional radiologists who use injections with certain chemicals, or dermatologists, who use laser therapy, to shrink these malformations.

Children with burns of the head and face are treated at the Craniofacial Center or the Burn Center of NewYork-Presbyterian Hospital/Weill Cornell Medical Center, which has one of the world's most advanced treatment centers for burns. Children with burn scars of the head or face can have these scars repaired with normal skin through skin grafting or the creation of flaps of the patient's own skin.

The Craniofacial Center

Each year in the United States, thousands of infants are born with cleft lip, cleft palate and other complex facial deformities. Trauma and facial tumors also result in significant facial disfigurement in children. Without the right treatment, babies with birth anomalies or young children whose faces are damaged by disease or injury are likely to grow up feeling rejected and isolated by the indignities they often suffer because of their appearance. Fortunately, many of these children can achieve a happy life. Treatment for disfiguration among children has been increasingly successful in recent decades and is still being advanced. The Craniofacial Center of NewYork-Presbyterian Morgan Stanley Children's Hospital holds a leadership position in helping children and their families to achieve a better future though a fully integrated, collaborative interdisciplinary program.

Many specialists are needed to provide the expert consultation and skillful care required to diminish the problems of craniofacial disfiguration. Timing of such care is critical to a successful outcome but, unfortunately, it is usually the child's parents or pediatrician who is left to struggle with coordinating the many steps in managing treatment. The Craniofacial Center solves this problem by providing comprehensive specialty consultation and care for children with deformities. Treatments plans are formulated on a long-term basis for children with craniofacial deformities. Center specialists meet and work together regularly to review the complex treatment plans that make an active and productive life possible for their young patients. Management plans are developed with active participation from patients' families to help them understand the options available for their child and to impart confidence in their choice of treatment.

The Craniofacial Center provides advanced care to children with facial conditions and complex facial deformities in three main areas: congenital birth defects, trauma, and tumor or abnormal growth. Specific areas of expertise include:

• cleft lip and palate
• swallowing, hearing and speech difficulties due to cleft palate and velopharyngeal insufficiency
• facial clefting syndromes, including Treacher Collins syndrome
• craniosynostosis syndromes, including Crouzons and Aperts syndromes
• branchial arch syndromes
• craniofacial trauma
• facial and jaw tumors and occlusal discrepancies
• dentofacial deformities and malocclusion
• congenital deformities of the eyelids, eye muscles and tear ducts
• vascular growths and malformations, including hemangiomas

Treatment

The Craniofacial Center brings together experts in:

• plastic and reconstructive surgery
• neurosurgery
• ophthalmic and oculoplastic surgery
• oral and maxillofacial surgery
• otolaryngology/head and neck surgery

Timely surgical management of infants and children with craniofacial anomalies is important to minimize the impact of these conditions on cranial and facial growth, development, final function, and appearance. Some children require reconstructive procedures at different times in their growth and development, depending on factors such as tissue maturation and facial bone growth. For example, when a newborn presents with a cleft lip and palate, surgical procedures will involve repair of the lip usually at about two to three months of age and repair of the palate when the child is about 6 to 15 months old. When the child is approaching school age, he or she may have another surgery on the back part of the palate to improve speech. Between the ages of 6 and 10, a bone graft may be performed. And when the child is 15 or 16, the upper jaw will be repositioned if necessary. Lip and nose procedures may also be done to improve appearance in early and late adolescence if not done sooner. Throughout this, the child may have orthodontic therapy to widen the upper jaw or put in a palate expander, and will he or she will also see a pediatric dentist to make sure that the teeth and gums are in good health and that oral health is maintained. Understanding the rationale for the timeline for reconstructive surgery and other procedures, including the use of orthodontics, is helpful to families.

The lives of our families can be challenging, coping with issues such as feeding and positioning an infant, insurance and managed care, and anxieties about the future. It is very common for families to feel overwhelmed. Each of our team members is dedicated to helping families cope and manage these and other matters that can arise. Strengthened by its multidisciplinary resources, the Craniofacial Center is fully prepared to assist parents and caregivers in every way that will help assure positive change in the lives of children afflicted by facial problems. Patients are frequently seen by several specialists in one visit. These specialists then meet together to discuss the case and develop a comprehensive treatment plan, facilitating a prompt recommendation to the family on next steps.

In addition to surgical specialists, the craniofacial team includes geneticists, speech and language pathologists, audiologists, occupational therapists, and social workers. A coordinator works with families to manage all levels of care and arrange the necessary appointments, explain treatments, and review the timeframe for the child's care. Pediatric neurologists aid in the diagnosis and management of children with neurodevelopmental challenges in the context of craniofacial conditions. Pediatricians supervise each patient's nutrition, growth, development and other general medical care issues. They also help coordinate the care provided by our team with the patient's primary care physician.

Surgical Specialties

The Center's plastic and craniofacial surgeons perform reconstruction of cleft lip and palate, ear malformations, facial asymmetry, skull malformations and craniosynostosis. In children in whom craniosynostoses cause irregularities in the shape of the skull or facial features, our plastic surgeons, in collaboration with other members of the craniofacial treatment team, can shift bones of the head and face into natural positions in a gradual, stepwise manner through the technique known as distraction osteogenesis, providing these children with a more normal appearance.

The oral surgeon's role on the craniofacial team is to provide for maxillofacial reconstruction, primarily of the bone. This includes treating patients who have acquired a deformity from trauma, tumors, or congenital abnormalities. They perform surgery to correct facial asymmetries and to adjust the alignment of the jaws and other facial structures as children grow. In craniofacial abnormalities, oral surgeons are involved in reconstructing the lower jaw and the upper jaw -- usually below the level of the eye. For instance, a child who has a cleft lip and palate may be missing bone in the cleft and upper jaw near the teeth. An oral surgeon will perform the bone graft to reconstruct this section. Oral surgeons also perform procedures to correct an abnormal growth of the upper jaw or deformity of the lower jaw.

Our otolaryngologists, or ear, nose and throat specialists, evaluate all concerns related to hearing and swallowing, and evaluate and manage children with respiratory problems that occur secondary to craniofacial conditions. Many children will have ear fluid or congenital abnormalities that interfere with their hearing. Otolaryngologists will identify these problems; perform surgery to treat any correctible hearing issues; and offer hearing aid support, including specially designed hearing aids based on cutting-edge technology and cochlear implants, to those children who can benefit. Our audiologists also perform auditory brainstem response testing, which evaluates brain waves at the brainstem level to determine hearing in response to sounds.

Our otolarynoglogists also evaluate and treat upper airway problems since craniofacial conditions can impact breathing. Flexible scopes allow them to perform these evaluations even in very small infants.

The Center's pediatric neurosurgeons treat infants and small children who have birth defects affecting the brain, skull and spine. They employ state-of-the-art approaches to treating children and adolescents recovering from head trauma and tumors. Our oculoplastic surgeons perform reconstruction of eye structures.

Oral Care

Treatment of craniofacial deformities require specialists in:

• pediatric dentistry
• orthodontics and dentofacial orthopedics
• maxillofacial prosthodontics

Infants and children with craniofacial anomalies will need specialized dental services. All children with clefts and craniofacial conditions are followed closely by our pediatric dentists. Comprehensive dental care, including preventative care and restorations, is provided to all children, no matter how complex their other medical problems. Dental care is an integrated part of the overall rehabilitative process. Services for these patients include not only primary dental care, but also routine ongoing maintenance throughout their life. Pediatric dentists care for infants with clefts, making individually tailored devices to enhance closure of the gap in the baby's gums and lips prior to surgery.

Orthodontists may be involved with the care of children at several stages from birth until they are fully grown at 18 or 19 or until all of their surgeries are complete. They will monitor craniofacial growth and development, perform pre-surgical procedures such as expanding the palate and preparing the patient's dentition (bite) to ensure post-surgical stability, correcting jaw discrepancies and dental arches in preparation for the surgical repair of lip and palate, bone grafting or orthognathic surgery, and monitor the success of a bone graft or other procedures.

Prosthetic appliances to assist in feeding or speech in the patient with cleft palate and to replace or restore oral and facial structures are also provided.

Speech and Language Pathology

Speech and language pathologists in the Craniofacial Center are responsible for evaluation and treatment of patients who present with speech, voice, and swallowing issues related to craniofacial disorders or syndromes that present with malformations or malfunctioning in the oral cavity. As members of the craniofacial team, speech and language pathologists participate in the decision-making process for sequencing surgeries and provide guidance for speech services patients may need at home or at school. Our speech pathologists perform assessments of the speech skills of patients and the pronunciation of certain consonants and vowels. They collaborate with otolaryngologists and reconstructive surgeons to find solutions for improved speech production.

Audiology

Hearing difficulties and middle ear dysfunction often occur in infants and children with craniofacial anomalies. The auditory system and pathways can be assessed at any age from neonatal/infancy though adulthood. Audiologic services available include otoacoustic emissions, auditory brainstem response testing, emmittance audiometry, behavioral audiologic evaluations including visual reinforcement audiometry and hearing aid evaluations/fittings. Testing and treatment is conducted by the Craniofacial Center's specially trained audiologists.

Feeding Therapists

Feeding therapists help to ensure that the infant or child is able to take in adequate nutrition and swallow food or liquid safely without complications such as pneumonia or other medical issues. Our therapists also work closely with parents to identify the best way to feed their child, teaching them feeding techniques and advising them on bottle selection so that their infant can take in enough nutrition and do so without discomfort. They also provide treatment if muscle weakness is present or a child has an aversion to certain types of food because of an early life experience.

Genetic Testing and Counseling

The Division of Genetics provides prenatal, pediatric, and adult diagnostic testing, including cytogenetic and DNA testing, for birth defects and/or genetic conditions. Genetic counseling is an integral component of the program, including a discussion of genetic risks for future offspring. The Craniofacial Center is staffed by a clinical geneticist, genetic counselors and supporting staff. Geneticists and genetic counselors help shed light on causes for birth defects and inheritance patterns. Our geneticists also provide reproductive counseling for parents of affected children and for adolescents with clefts and congenital conditions who are reaching the age of reproductive awareness.

Social Services

Social workers assist in helping families gain access to resources and services; facilitate medical, dental and surgical care of children; and also help with entry into long-term social service programs. Our social workers also facilitate communication with families who are adjusting to the birth of a child with a facial deformity, or who are adjusting to a change in a child's appearance due to trauma or disease.