Our comprehensive approach to your surgery has three objectives, in which two surgeons collaborate to complete:
- Perform a sound tumor operation
- Prevent short and long-term complications
- Maintain or improve your facial aesthetic appearance after surgery.
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.
How can a sunken appearance in my face be prevented after surgery?
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 may leave 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, requiring sculpting to successfully reconstruct this facial area. Nearly all patients ask for this saggy skin to be re-contoured and tightened during closure. Many patients also 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 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, 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 the initial surgery. There is less risk of injury to the facial nerve during the initial surgery.
How will my cheek be repaired?
Problem: Removal of parotid tumors requires removing some normal parotid tissue around the tumor to prevent regrowth. Unfortunately, this results in 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.
Can my cheek be corrected with 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.
Non-Surgical Correction of Facial Deformity
Can my sunken face be corrected after surgery?
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.
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.