Fat grafting, also called fat transfer or autologous fat transfer, is a technique that uses your body’s own fat to restore volume in another part of the body where there is a deficiency in soft tissue volume due to aging, surgery or a medical condition. Liposuction is used to harvest the fat through small, easily concealed incisions. Fat grafting can be used for a number of cosmetic and reconstructive problems. Some of the common uses of fat grafting include:
Cosmetic Purposes Include:
- Treating signs of aging including deflated cheeks and lips
- Augmenting breast volume
- Buttock Augmentation
Reconstructive Purposes for Fat Grafting Include
- Facial asymmetry due to hemifacial microsomia
- Facial asymmetry due to Parry Romberg Syndrome
- Contour irregularities due to Linear Scleroderma
- Improving skin changes in radiated tissues
- Improving breast contour in implant based breast reconstruction
Dr. Derderian’s Goal for Fat Grafting (Fat Transfer)
Fat grafting has a wide range of applications. For many conditions fat grafting may be considered as a permanent or long-lasting filler to restore volume. Whether your condition requires a cosmetic or reconstructive application for fat grafting, Dr. Derderian’s goal for your treatment is to provide a long-lasting solution to address your concerns with a natural and aesthetically pleasing result.
Am I a Candidate for Fat Grafting (Fat Transfer or Autologous Fat Transfer?
Ideal candidates for fat grafting are healthy and do not smoke. Frequent reasons to seek fat grafting include:
- Facial asymmetry
- Age-related deflation of the soft tissues of the face including the temples, cheeks, lips and nasolabial folds
- Parry Romberg Syndrome – contour irregularity of the temples, cheeks, lips, chin and jawline
- Linear Scleroderma – Contour irregularities of the forehead, brow, orbit and scalp
- Radiation related skin changes – woody hard skin; contracture; ulceration
- Breast deflation after implant removal
- Breast contour irregularity after surgery
- Breast Augmentation
- Buttock Augmentation
What Happens at Consultation?
It is important that you arrive at your consultation with specific goals for what improvements you want for your appearance and have realistic expectations for what can be achieved with fat grafting. Dr. Derderian will perform a detailed history and examination with special attention paid the skin and subcutaneous tissues in the area of your concern in addition to areas of potential donor sites. Common donor sites include the abdomen, flanks, hips, buttock and thighs. He will discuss your specific goals in detail at your consultation and will develop a surgical plan tailored to your anatomy and goals.
How is the Surgery Performed?
Fat is harvested using standard liposuction techniques. Small incisions of about a quarter inch size are used for the liposuction cannulas. The fat is washed with saline to ensure only healthy fat is used. Specialized blunt injection cannulas are used to place small amounts of fat into the recipient tissues. This is a precise process and it is important that only small amounts are placed. The amount of fat that can be placed in a single treatment depends on the thickness of the recipient tissues. Depending on how much volume is needed to achieve your treatment goals a series of injection treatments may be needed. For small volumes a single treatment can be successful. For larger volumes 3-4 treatments are needed. These may be separated by 4-6 months.
The recovery from fat grafting is well tolerated. Usually the amount of fat harvested is much less than what is removed during liposuction for contouring purposes. Patients use prescribed pain medicine for 1-3 days. Antibiotics are taken for 1 week to protect against infection while the grafted tissue is developing a blood supply. There is swelling after the procedure, but this is sufficiently resolved after 7-10 days to go back to school or work. Patients can return to full activity after 2 weeks.
When is the Final Result Appreciable?
Improvements in volume and contour are immediately appreciated after fat grafting. What is difficult to determine is how much of the transferred fat will survive. Estimates on graft survival depend on the thickness and health of the tissues at the recipient site. On average, about 50% of the transferred fat will survive. It takes about 4-6 months for the edema to resolve sufficiently to assess if enough graft has taken to achieve the treatment goal.
What is the Cost of Fat Grafting (Fat Transfer)?
The cost of fat grafting depends on the nature of the problems. For reconstructive purposes it is typically covered by insurance. Cosmetic applications are not covered by insurance.
The costs for surgery include:
- Anesthesia fees – cover the anesthesiologist, their staff and medications
- Hospital or surgical facility costs – covers the operating room, staff and equipment
- Surgeon’s fee
Why Choose Dr. Derderian?
Dr. Derderian trained in plastic surgery at New York University and after completing his residency Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania. He had extensive training in fat grafting during his training. He joined the faculty at UT Southwestern in Dallas in 2011. Dr. Derderian is board certified by the American Board of Plastic Surgery and is a recognized expert in cosmetic and reconstructive surgery. Dr. Derderian frequently performs fat grafting in his practice in Dallas, and performs basic science and clinical research related to fat grafting.
Linear scleroderma is an autoimmune condition that causes focal atrophy of the skin, fat and muscle of the brow, forehead and scalp. There is also variable increased or decreased pigmentation of the skin. The classic finding of linear scleroderma is called the en coup de sabre (Strike of the Sabre) – a vertical, linear indentation of the forehead. Hairless patches (alopecia) may also be found in the scalp and occasionally the upper eyelid and the bone of the eye socket (orbit) can be involved. Linear scleroderma falls under the same umbrella diagnosis of Morphea, also called localized scleroderma. Morphea is an autoimmune condition that results in atrophy of the subcutaneous tissue and changes in the skin quality and pigmentation in other parts of the body also. It is not known why these focal autoimmune conditions occur and why they selectively affect different parts of the body and face.
TREATMENT
How and when to treat patients with linear scleroderma remains controversial. The conventional way to approach treatment was to let the disease continue to progress until a final steady state was achieved. This was also called letting the disease “burn out.” Today a number of immune modulators may be used to slow or arrest the progression of the tissue loss. Some experts believe that early attempts at reconstruction may also cause arrest or decrease the rate of progression of the disease. Careful coordination with the other providers involved in caring for you is important, including your dermatologist and/or rheumatologist. The main way to treat the changes in the soft tissues of the forehead and brow is called fat grafting or fat transfer.
HOW IS THE SURGERY PERFORMED?
Fat grafting uses the patient’s own fat that is harvest by performing liposuction. Typically the fat is harvested from the flank, hip or abdomen. Usually only 1-2 tablespoons of fat can be injected per treatment because the tissues are very thin. The fat is injected between the skin and muscle and between the muscle and bone in the areas where thinning of the tissues has occurred. Special thin, blunt injection needles are used to avoid injury to the skin, muscles, nerves and blood vessels in the treated area. The treatment must be performed 1-3 times, depending on the severity of the soft tissue loss. Fat grafting is performed at 4-6 months intervals between each treatment to allow the tissues to completely heal between treatments.
RECOVERY
Typically patients require prescribed pain medicine for a day or two and then just over the counter pain medications as needed for a week. Mild soreness at the donor site and recipient sites is common. Patients return back to school, work and activities of daily living in 1 week. They resume normal exercise and sports in 2-3 weeks.
AM I A CANDIDATE FOR FAT GRAFTING
The best candidates for surgery are healthy and do not smoke. Fat grafting can be safely performed in almost everyone.
Common problems treated with fat grafting include:
- Thinning of the temples
- Linear depression of the forehead (en coup de sabre)
- Depression of the forehead bone or brow (bone under eyebrow)
COST OF SURGERY
Fat grafting for the treatment of linear scleroderma is typically covered by insurance.
WHY CHOOSE DR. DERDERIAN?
During his plastic surgery residency at New York University Dr. Derderian had extensive exposure to the surgical treatment of patients with Linear Scleroderma and Parry Romberg syndrome. Dr. Derderian is board certified by the American Board of Plastic Surgery. He performs clinical research with Dr. Heidi Jacobi who is a dermatologist at UT Southwestern and a recognized expert in treating patients with Morphea, Parry Romberg and Linear Scleroderma. Their research includes evaluating the three dimensional changes in facial symmetry that occur with disease progression and after treatment with fat grafting. Dr. Derderian frequently performs fat grafting for patients with Linear Scleroderma and Parry Romberg syndrome at both UT Southwestern and Children’s Health in Dallas, TX.
Parry Romberg syndrome, also called progressive hemifacial atrophy, is an acquired autoimmune disease that causes progressive atrophy (wasting away) of the tissues underneath the skin of the face. This primarily affects the fat under the skin (subcutaneous tissue), but it also causes changes to the overlying skin that becomes thin and occasionally has increased or decreased pigmentation. The muscles of the face can be affected in various ways also. The majority of people who have this problem develop symptoms before 20 years old, but it can affect patients of any age. If the age of onset is during childhood Parry Romberg syndrome can also affect the growth of the underlying facial bones that may further affect appearance and create abnormal jaw relationships. The most common areas affected Parry Romberg syndrome are the temple, cheek, lips, nose, chin and jawline. Collectively, these changes create an uneven appearance to the face that looks unnatural. The wasting away of the tissues give a skeletonized or very aged appearance to one side of the face.
Parry Romberg syndrome falls under the umbrella diagnosis of Morphea, that is also called localized scleroderma, that is an autoimmune condition that results in atrophy of the subcutaneous tissue and changes in the skin quality and pigmentation in other parts of the body also. Linear scleroderma is a focal atrophy of the skin, muscle and fat of the forehead and scalp heralded by the en coup de sabre (Strike of the Sabre) – a vertical, linear indentation of the forehead. Linear scleroderma also falls under the same umbrella diagnosis of morphea. It is not known why these atrophy conditions occur and why they selective affect different parts of the body and face.
TREATMENT
How and when to treat patients with Parry Romberg syndrome is controversial. The traditional approach to treatment was to let the disease continue to progress until a final steady state was achieved. This was also called letting the disease “burn out.” This is less commonly done today because the disease can have irreversible effects on the skin, subcutaneous tissue and underlying bone if left unchecked by treatment. Today a number of immune modulators may be used to slow or arrest the progression of the tissue loss. Some experts believe that early attempts at reconstruction may also cause arrest or decrease the rate of progression of the disease. Careful coordination with the other providers involved in caring for you is important, including your dermatologist and/or rheumatologist.
The 2 main ways to treat the changes in the soft tissues of the face are
fat grafting (fat transfer) or
free flap reconstruction. The primary considerations for deciding between fat grafting and free flap reconstruction are related to the amount of donor fat available and what is needed to restore symmetry and normal appearance. For most patients the small amount of fat needed for fat grafting (3-5 tablespoons per treatment) can be harvested easily and the patients prefer the shorter and easier recovery of fat grafting. Occasionally very thin patients who require larger volumes of soft tissue to achieve symmetry in the face are only candidates for free flap reconstruction.
HOW IS THE SURGERY PERFORMED?
Both approaches are performed under general anesthesia. Fat grafting uses the patient’s own fat that is harvest with liposuction. The fat is injected under the skin into the areas where thinning of the tissues has occurred. Special thin, blunt injection needles are used to avoid injury to the skin, muscles, nerves and blood vessels in the treated area. The treatment must be performed 2-4 times, depending on the amount of volume restoration required to achieve facial symmetry. Fat grafting is performed at 4-6 months intervals between each treatment. Dr. Derderian prefers performing fat grafting over free flap reconstruction whenever possible. Free flap surgery is described below but the remainder of the treatment information will be for fat grafting as this is used in the vast majority of patients.
Free flap reconstruction uses a large section of fat and skin from the back – next to the shoulder blade (parascapular flap) – to replace the bulk that was lost due to Parry Romberg. This approach uses specialized microsurgery techniques to isolate the blood vessels that feed the flap of back tissue that are cut and connected to blood vessels in the face using a surgical microscope. The new blood vessel connections allow the back tissue to survive in the face. The blood vessel connections are monitored for several days in the hospital to make sure that blood clots do not form at the site of the connections that may interfere with blood flow. In 5-10% of cases the blood vessel connections do not remain open and cannot be salvage and the flap of back tissue must be removed without an improvement in appearance. For the majority of patients free flap reconstruction is successful, but patients often need some minor revision surgeries in the future. The main advantage of free flap reconstruction is that a greater change in appearance can be provided rapidly. The primary downsides are the longer recovery period and scarring on the back from the donor site, and the rare occasion that the free flap fails.
RECOVERY
Fat grafting is used to treat the majority of patients because the surgery is more straight-forward and the recovery is much quicker. Typically patients require prescribed pain medicine for a day or two and then just over the counter pain medications as needed for a week. Patients return back to school, work and activities of daily living within 1 week after surgery. They resume normal exercise and sports in 2-3 weeks.
AM I A CANDIDATE FOR FAT GRAFTING
The best candidates for surgery are healthy and do not smoke.
Common problems treated with fat grafting include:
- Thinning of the temples
- Deflated appearance of the cheek
- Deepening of the nasolabial fold (fold between cheek and upper lip)
- Wasting of the tissues of the nostril and nasal asymmetry
- Thinning of the upper and/or lower lip
- Asymmetry of the chin and jawline
COST OF SURGERY
Fat grafting for treatment of Parry Romberg is typically covered by insurance.
WHY CHOOSE DR. DERDERIAN?
During his plastic surgery residency at New York University Dr. Derderian had extensive exposure to the surgical treatment of patients with Parry Romberg syndrome while working with Dr. John Seibert, a world-renowned expert in free flap reconstruction for treatment of Parry Romberg syndrome. Dr. Derderian is board certified by the American Board of Plastic Surgery. He performs clinical research with Dr. Heidi Jacobi who is a dermatologist at UT Southwestern and a recognized expert in treating patients with Morphea, Parry Romberg and Linear Scleroderma. They are evaluating the three dimensional changes in facial symmetry that occur with disease progression and after treatment with fat grafting. Dr. Derderian frequently performs fat grafting for patients with Parry Romberg syndrome at both UT Southwestern and Children’s Health in Dallas, TX.
A Nasal Fracture, commonly called a broken nose, is a very common injury. Noses may be broken due to a sports injury, an automobile accident, a fall, or some other type of personal injury. Dr. Derderian frequently treats patients both immediately after their injury, or if they develop long-term consequences after trauma.
What Are the Symptoms of a Nasal Fracture?
A nose bleed after the injury is almost universally reported by patients with nasal fractures, but having a nose bleed does not mean that your nose is broken. The most common findings are pain, swelling, difficulty breathing through the nose, or your nose might suddenly look crooked or different in some other way. If you believe your nose has been broken you should seek medical attention. A CT scan is frequently performed to make the diagnosis. If you suspect that your nose is broken or have been told by a healthcare provider it is important to contact our office immediately so all treatment options are available to you.
How Do You Treat a Nasal Fracture?
Dr. Derderian’s approach to repairing a nasal fracture is different for each patient, depending on the time from the injury, nature and severity of the fracture. If the bones are broken but not displaced, then conservative management with observation is recommended. For patients with displaced nasal fractures who are seen within 7-10 days of the injury a closed reduction of the nasal fracture is attempted. In a closed reduction of a nasal bone fracture the patient undergoes a brief general anesthetic. The nasal bones are set (reduced) back into their normal position. Occasionally the bones are too badly broken to achieve stable reduction, but for most patients sufficient reduction of the nasal bones is achieve to restore normal appearance and function.
Occasionally patients do not notice that their nose is crooked, or the breathing problems may get worse over time. If patients present after 7-10 days from the time of injury they will require a septoplasty or rhinoseptoplasty operation to straighten the nose and nasal septum in order to improve the appearance of the nose and restore normal breathing. See the septoplasty and rhinoplasty sections for more details.
Dr. Derderian’s Approach to Nasal Fracture Surgery
It is critical to have an experienced surgeon treat your nasal fracture. During his residency Dr. Derderian had extensive training in nasal trauma, septoplasty and rhinoplasty at New York University and the Manhattan Eye Ear and Throat Hospital (MEETH). Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia where he received additional training in facial trauma and post-traumatic rhinoplasty. Dr. Derderian is board certified by the American Board of Plastic Surgery and he is an expert in rhinoplasty. He frequently performs septoplasty and rhinoplasty in both his pediatric and adult practices for treatment of crooked noses and breathing difficulty secondary to nasal trauma. He has been invited yearly as an instructor at the world renowned Dallas Rhinoplasty Symposium since arriving in Dallas in 2011.
What are Facial Fractures?
A facial fracture is any broken bone in the face. The most common facial fractures the nose, cheekbones, eye socket, and jaws. The fracture may be the result of a car accident, sports trauma, or personal injury. Whatever the cause, the patient often feels emotional distress about the potential for both function concerns and a change in facial appearance. Dr. Derderian is a craniofacial surgeon with expertise in treating facial fractures. He frequently cares for patients with facial fractures to restore their function and appearance.
What Are the Symptoms of Facial Fractures?
The symptoms created by facial fractures vary depending on which bones are injured. The most common symptoms are severe pain, bruising, swelling, numbness, difficulty breathing through the nose, teeth not fitting together correctly (malocclusion) and double vision. If the cheek bones and/or eye socket are involved you may have a flatness or sunken appearance around the cheeks and eyes, or the yes may appear to have a different shape.
If you have suffered a facial fracture, it is important to schedule an appointment with Dr. Derderian as soon as possible so that he can assess the injury, determine if there is any other damage, and recommend a course of action. It is important to treat facial fractures within 7-14 days, before the bones heal in the abnormal position. Dr. Derderian will perform a physical examination and may order X-rays or other diagnostic tests to assess the full extent of the damage.
How Does Dr. Derderian Treat Facial Fractures?
The treatment plan depends on the location and severity of your fractures. Dr. Derderian will review CT scans so you can see where the fractures are and he will discuss the details of the treatment plan. The also recovery depends on the type of fracture. Most patients are able to return to work or school in 7-10 days after surgery.
Dr. Derderian’s Approach to Facial Fractures
Dr. Derderian had extensive training in facial trauma at New York University. After completing his residency Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania where he specialized in performing complex reconstruction of the skull and facial bones. Dr. Derderian is board certified by the American Board of Plastic Surgery and he is a nationally recognized expert in craniofacial surgery. Craniofacial surgery makes up over 50% of Dr. Derderian’s clinical practice and it is also the focus of his clinical research.
Cleft rhinoplasty is the term used for nasal reshaping surgery for fully grown patients with an uneven nasal appearance due to cleft lip and palate. Babies born with cleft lip and palate have characteristic changes to the shape of their nose. The nasal shape is usually treated surgically during the lip repair as an infant. Some patients also have a “touch up” surgery to balance the tip of the nose again between 5-10 years old. Regardless of the number of nasal surgeries in early childhood the significant nasal growth that occurs during puberty creates an uneven nasal shape. The nasal growth is uneven due to scarring created from the previous surgeries and residual asymmetry in the nasal cartilage, nasal septum and nasal bones. Together these cause abnormal growth of the nose that results in an unnatural nasal appearance. Cleft Rhinoplasty is widely considered to be the most difficult rhinoplasty to achieve consistently good results and have an experience surgeon is critical to achieve an aesthetically pleasing and natural appearance after cleft rhinoplasty.
Dr. Derderian is an expert in cleft rhinoplasty and frequently performs cleft rhinoplasty at his practice in Dallas. He customizes his approach to each patient based upon the patient’s nasal anatomy and goals for change in their appearance. Cleft rhinoplasty is frequently combined with procedures to improve breathing through the nose such as septoplasty for deviated septum and turbinate reduction.
This page will discuss cleft rhinoplasty that is the term used for nasal reshaping for patients with a nasal deformity due to cleft lip and palate.
Common reasons why patients seek Cleft Rhinoplasty include:
- Reshape a nasal tip that is poorly defined, uneven and wide
- Increase Projection of the Nasal Tip
- Change the size and/or shape of the nostrils
- Straighten a crooked nose
- Improve the profile by lengthening a short nose
- Improve the profile by removing bumps or dips in the bridge of the nose
- Change the size and shape of the nose to improve facial balance
- Improve breathing through the nose
Cleft rhinoplasty is far more difficult than typical primary or secondary rhinoplasty for a number of reasons. The anatomy of the nose has never been fully normal and the abnormally shaped skin, cartilage and bones have been altered and scarred by surgery. There is usually less cartilage available for grafts needed to reshape the nose. Perhaps the most challenging factor is that the skin and soft tissues of the nose are scarred which makes reshaping the nose far more difficult than it is in a nose without previous surgery or injury.
Am I a good candidate for Cleft Rhinoplasty?
It is typically best to wait at least 1 year from the time of the most recent nasal surgery to seek consultation for cleft rhinoplasty. This provides time for swelling to fully resolve and gives the healing process time to complete and allow the skin and soft tissue to soften. The best candidates for cleft rhinoplasty are physically and psychologically healthy, do not smoke and have realistic goals for what can be achieved from surgery.
How Is The Surgery Performed
Dr. Derderian uses an open approach to cleft rhinoplasty because the open approach allows direct visualization of the nasal cartilages. Open rhinoplasty requires a small incision in the columella (the skin between the nostrils) through which the skin of the nose is elevated off of the underlying cartilage and bone. This incision typically heals with an imperceivable scar.
The duration of surgery varies from patient to patient. Typically the procedure takes 3-4 hours. During surgery the skin is elevated from the underlying cartilage and bone. Depending on the strength and position of the cartilage and bone and the goals of surgery, a variety of maneuvers are used to reshape the nose and improve breathing. Graft material is needed in every cleft rhinoplasty to change the shape of the nose. Cartilage from the nasal septum is the easiest site to get cartilage grafts from, and the nasal septum usually requires straightening during the procedure. A large amount of graft material is needed to reshape the nose in cleft rhinoplasty because the skin and soft tissues are very scarred and stiff. If more cartilage is needed to support the new nasal shape, the cartilage may be harvested from the patient’s ears or ribs. Dr. Derderian frequently uses an alternative source of rib cartilage harvested from donors that has been treated to remove all immune markers that prevents rejection of the graft. Using donor cartilage avoids additional pain and recovery for the patient.
After the desired changes in shape are achieved the nose is closed with fine stitches. At the end of surgery soft splints may be placed inside your nose to support the nasal septum. Soft splints are frequently used on the outside of the nose also to help shape the skin. Tapes and a splint are placed over the nasal bridge to support and protect the nose for 7 days. After recovering from anesthesia you will be taken home the same day as surgery by the family or friends who bring you to the hospital.
WHAT IS THE RECOVERY PERIOD?
Minimal activity is recommended for the next week. Most patients take a week off from work or school. Oral pain medication is used for 2-3 days. Splints and sutures are removed after 7 days. No vigorous activity is allowed for 3 weeks. After 3 weeks normal cardiovascular exercise and non contact sports may be resumed gradually. No restrictions on activity after 6 weeks.
The majority of swelling subsides within a few weeks after surgery, but it takes one year for your new nasal contour to fully refine. During this time, your nose will look normal but you may notice gradual changes in the appearance of your nose as it refines to a more permanent outcome.
What Does Rhinoplasty Cost?
Cost may include:
- Anesthesia fees – cover the anesthesiologist, their staff and medications
- Hospital or surgical facility costs – covers the operating room, staff and equipment
- Surgeon’s fee
Why Choose Dr. Derderian?
It is critical to have an experienced surgeon perform your cleft rhinoplasty. During his residency Dr. Derderian had extensive training in cleft rhinoplasty at New York University with Dr. Court Cutting, a world-renowned authority in cleft surgery. After completing his residency, Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia where he received additional training in cleft rhinoplasty. Dr. Derderian is board certified by the American Board of Plastic Surgery and is a member of the Cleft and Craniofacial Team at Children’s Health Dallas. He frequently performs cleft rhinoplasty in both his pediatric and adult practices. He has been invited yearly as an instructor at the world renowned Dallas Rhinoplasty Symposium since arriving in Dallas in 2011.
View Before-After Photos
Cleft lip and palate are the most common congenital anomalies of the face and skull, affecting approximately one in 700 newborns in the U.S. Infants with cleft lip have variable degrees of change in the appearance of the lip and nose depending on whether or not the gums and palate are involved. When there is a complete cleft of the lip, gums and palate there is a wider separation in the bones of the gums and palate that creates a wide gap between the lip segments and drastically changes the shape of the nose. The standard timing for repair of cleft lip is during infancy. Today the cleft nasal deformity is frequently addressed as an infant also. Occasionally patients will have revisions of both the cleft lip and nose during childhood and/or the teenage years. Despite having a cleft lip repair, and maybe one or more revisions, it is not uncommon that patients are unhappy with the appearance of their lip or nose when they reach adulthood. In many ways these patients feel like a lost population because they do not know where to turn. Dr. Derderian frequently performs revision of cleft lips in children and adults. He also frequently combines lip revision with cleft rhinoplasty.
Dr. Derderian’s Goal for Your Cleft Lip Revision
Patients with significant scarring, lip asymmetry and/or abnormal lip contour after cleft lip repair seek revision to reduce unwanted attention and improve their self-esteem. Dr. Derderian’s goal is to provide a softer and natural appearance for patients with residual scarring or abnormal lip appearance due to cleft lip and palate. He approaches adult cleft lip revision and cleft rhinoplasty with the same meticulous attention to detail that he brings to cosmetic procedures. Dr. Derderian wants his patients to feel that people are focused on them and not their cleft lip by the end of their treatment.
Am I a Candidate For Cleft Lip Revision?
Cleft lip revision can be performed at any age. If you have reached skeletal maturity, that is age 16 for young women and age 18 for men, the primary consideration before proceeding with lip revision is if you need jaw surgery or not. The upper lip drapes across the upper teeth and changing the position of the upper jaw can impact the lip posture significantly, so it is better to wait until after jaw surgery to revise the lip. For older patients, you have likely completed orthodontic treatment and/or jaw surgery. Ideal candidates do not smoke, are in good health and have their medical issues well managed by their primary care physician. Cleft lip revision is frequently performed in conjunction with cleft rhinoplasty. Common reasons why people seek cleft lip revision include:
- Poor scars in the lip after cleft lip repair
- Uneven appearance to the upper lip
- Imbalance between the bulk of the upper and lower lip
- Deflated appearance to the entire upper lip
- Decreased bulk in the center of the lip
What Happens at Consultation for Adult Cleft Lip Revision?
You will meet with Dr. Derderian to discuss your concerns about the appearance of your lip and the specific goals you have for improving your appearance. A complete history and examination will be performed to ensure that you are a good candidate for surgery. After verifying that you are a good candidate, Dr. Derderian will develop a customized plan tailored to your anatomy to achieve your goals for change. He will explain the plan in detail and answer all of your questions.
How is Adult Cleft Lip Revision Performed?
The procedure for cleft lip revision can vary dramatically. Small deficiencies of bulk or slight asymmetries may be addressed with very minor procedures. In some cases the result of the previous surgeries requires a complete re-repair of the lip that is as extensive as a primary cleft lip repair. The same strategies used for concealing scars in primary cleft lip repair are used in lip revision. The goal is to hide scars in the prominent features of the lip the generate light reflexes. If the scar follows the patterns of the normal anatomy of the lip the scars will be much less noticeable.
What is the Recovery of Cleft Lip Revision?
The lips are swollen after the procedure. Most of the swelling is resolved by 7-10 days after surgery. Sutures are usually removed at 5-7 days after surgery. Patients eat a soft diet for 1 week after surgery because it is more comfortable. Patients feel comfortable returning to school or work after 10-14 days. Normal exercise can be resumed after 2-3 weeks. Dr. Derderian recommends silicone gel application to the scars for 3 times per day for 4-6 months. Normal sun precautions are taken to protect the scars.
When is the final Result Appreciable?
While the symmetry and overall appearance of the lip is improved at 7-10 days after surgery, the final result is not appreciable until the scars have fully matured. The pink color leaves the scars at 4-6 months after surgery and the scars have fully matured between 6-12 months after surgery.
What is the Cost of Cleft Lip Revision?
Cleft lip is a congenital condition, therefore most insurance companies will cover treatment of cleft lip including adult cleft lip revision. Dr. Derderian’s staff will discuss the possible costs with you in detail. If your insurance does not cover cleft lip revision the costs will include:
- Anesthesia fees – cover the anesthesiologist, their staff and medications
- Hospital or surgical facility costs – covers the operating room, staff and equipment
- Surgeon’s fee
Why Choose Dr. Derderian?
It is critical to have an experienced surgeon perform your cleft lip revision. During his residency Dr. Derderian had extensive training in cleft lip surgery at New York University with Dr. Court Cutting, a world-renowned authority in cleft surgery. After completing his residency, Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia where he received additional training in cleft lip revision. Dr. Derderian is board certified by the American Board of Plastic Surgery and is a member of the Cleft and Craniofacial Team at Children’s Health Dallas. He is the primary cleft surgeon for hundreds of patients with cleft lip and palate. He frequently performs primary cleft lip repair, cleft lip revision and cleft rhinoplasty in both his pediatric and adult practices. He is a nationally recognized authority in cleft surgery.
What is an Ear Deformity Surgery?
Dr. Derderian may perform an ear deformity surgery to repair an underdeveloped outer ear, reshape protruding or pointy ears, or remove an excess skin fold.
How do Ear Deformities Occur?
Ear defects can result from the improper development of an ear during pregnancy, some type of trauma, or cancer removal surgery. The patient often suffers severe emotional distress about his or her appearance. Dr. Derderian relies on his in-depth understanding of facial anatomy in all of his partial or total ear defect reconstruction surgeries. His goals are to provide a natural-looking ear, achieve facial symmetry, and maintain hearing capabilities.
What Happens During an Ear Deformity Surgery?
Although each ear reconstruction surgery is unique, Dr. Derderian usually begins by making an incision behind the existing ear area. In some cases, he may then remove and reshape the existing cartilage and skin to achieve the desired effect. For other cases he may need to add to the existing tissue in order to create a more natural appearing ear.
How Do I Recover From an Ear Deformity Surgery?
Depending on the extent of your procedure, you may need to have dressings or a headband on the surgical area for a few days after the procedure. You may experience some mild discomfort, but let our staff know immediately if you feel any significant amount of pain. You will not be able to sleep on your side for a week or so, in order to not disturb the healing process.
Dr. Derderian’s Approach to Ear Deformity Surgery
Dr. Christopher Derderian has extensive fellowship training and is board-certified in plastic surgery, which distinguishes his training and credentials from many other doctors. He possesses diagnostic acumen, precise surgical technique, and an advanced understanding of facial anatomy and physiology. He utilizes the most advanced treatment techniques available today. A consultation and physical examination can help point a way to the best approach to your ear deformity surgery needs.
Just like noses, eyes and lips, ears can look quite a bit different from one person to the next, but our minds will see almost all of them as normal. There are some key features that our minds look for when determining if an ear appears normal or not. Ear reconstruction is performed to restore missing parts of the ear or completely replace missing ears. Partial reconstruction of the ear is commonly performed for some congenital ear shape differences and loss of parts of the ear after trauma or after Mohs surgery or cancer surgery. Reasons to create an entirely new ear include for congenital absence of the ear (microtia) or surgical or traumatic amputation of the ear. For more information on ear reconstruction for microtia visit Dr. Derderian’s pediatric website drderderian.com.
Ear Reconstruction of Part of the Ear
There are many options for treating each partial ear deformity. The considerations include the parts that are missing, the condition of the surrounding tissues and the desires of the patient with regard to the time and number of steps to the reconstruction and the degree of refinement they desire in the outcome. Below is a case example showing a patient with a traumatic injury to the helical rim and after a 2-stage reconstruction using skin from behind the ear to replace the missing soft tissue.
Total Ear Reconstruction
There are three main approaches to reconstruction of the external ear. The first method uses an implant called Medpor to create a normal appearing ear. The second, also the oldest approach to ear reconstruction, uses the patient’s rib cartilage. The rib cartilage is harvested from the chest and carved and assembled into a framework with a shape similar to the Medpor framework. The third method is to use a prosthetic ear that is glued to the skin with adhesive or anchored to implants in the bone. This prosthesis can be removed.
Rib Cartilage Ear Reconstruction
This approach is the oldest and most widely performed technique for ear reconstruction. It has been used for over 50 years. This approach is usually performed at age 10 years of age or older. The general idea is to harvest the strong cartilage from the rib cage, carve this cartilage and assemble it into a framework using wires or suture material. The framework is placed under a skin pocket in the location of the microtia to create a new external ear.
Dr. Derderian does not favor the rib cartilage approach for total ear reconstruction. Deformity and pain in the chest donor site, the number of surgeries required and the poor quality of the average result are all reasons why he favors a Medpor-based approach to ear reconstruction.
Am I a Candidate for Ear Reconstruction?
If you have an ear deformity you may be a candidate for any number of approaches to ear reconstruction. The nature of your ear deformity and previous surgeries will be important considerations. The quality of the surrounding soft tissues impacts the available options for ear reconstruction. Dr. Derderian will perform a history and examination and will discuss the available options with you in detail. He will customize options for treatment based upon your goals and the anatomy of your ear and the surrounding tissues. It is important to have realistic expectations for what ear reconstruction can provide.
What is the Recovery?
The recovery depends on the nature of the ear deformity. For most patients the surgeries are ambulatory, meaning you come in and go home the same day. Total ear reconstruction patients will often stay one night in the hospital. The recovery period varies based upon the number of stages to the reconstruction and what donor tissues are used for the reconstruction. In general the reconstructions are not painful.
When is the final result appreciable?
There may be 1-3 stages to your ear reconstruction based upon the nature of the deformity. Regardless of the number of steps, the ear will have normal contour and coloration within 2-3 months of the last stage of reconstruction. It usually takes 6-12 months for the skin to completely normalize in coloration.
What is the Cost of Surgery?
Ear reconstruction surgery is covered by most insurance providers. Out of pocket expenses for those without insurance include:
- Anesthesia Fee
- Facility fee
- Surgeon’s fee
Why Choose Dr. Derderian?
Dr. Derderian developed a passion for ear reconstruction early in his training. During his plastic surgery residency at New York University he had extensive training in ear reconstruction with Dr. Charles Thorne, a world-renowned expert in ear surgery. After completing his residency, Dr. Derderian did a fellowship in craniofacial surgery at the University of Pennsylvania and Children’s Hospital of Philadelphia where he received further dedicated training in ear reconstruction with Dr. Scott Bartlett. Dr. Derderian is board certified by the American Board of Plastic Surgery. He is a well-recognized expert in ear reconstruction for acquired and congenital anomalies such as microtia and constricted ears and he regularly performs ear reconstruction in both his pediatric and adult practices. Dr. Derderian is frequently asked to give lectures about ear reconstruction and has multiple publications detailing his approach to ear reconstruction.
