Head and Neck Reconstruction
Reconstruction of the head and neck with Fat Grafting
Patient with facial atrophy on the left side of her face, which was treated with two Coleman fat grafting sessions. After (below) patient returns at 15 months with much fuller, healthier face. The key to treating this type of atrophy is to avoid over filling.
Congenital deformities of the head and neck resulting from injury, surgery, medication or medical treatment, radiation, burns or chemical injury can be devastating, particularly when they involve a child or younger adult. Motor vehicle accidents, dog bites, cancer surgery, defects from injections of steroids or other toxic chemicals and military injuries can leave the head and neck with large defects, holes or dents. Fat is the ideal reparative agent in these cases, because it can be placed wherever it is needed to reshape an area, fill in a hole or dent, make the face more symmetric and improve healing of injured tissues by virtue of its stem cell component. Dr. Coleman has treated many unusual conditions, injuries and cancer-related deformities over the years using fat. He is involved in a research and treatment program using fat grafting to treat injured veterans sponsored by the US Military through the Department of Defense. Autologous fat grafting shows much promise as a treatment for war wounds such as shrapnel injuries, skull and facial bone defects, amputated limbs (including painful ones), and burns.
Patient had craniotomy for aneurysm over one year before and was left with a significant dent in his left temple going up into his hairline. He also had strange sensations in the area. 2 ½ years after the second of two procedures, the patient not only has a smoother skull, but also his nerve sensation problems have improved.
The team at TriBeCa Plastic Surgery is particularly gratified when we can improve the appearance of adults or children treated for cancer, born with congenital deformities, or damaged by accident, radiation or surgery. We have successfully treated congenital facial deformities such as Treacher Collins syndrome, skull deformities from injuries or brain surgery, facial asymmetry caused by surgery, neurologic problems, hemi-facial paralysis, radiation and chemotherapy, and scarring from thermal and chemical burns. We can place fat exactly where it is needed to “sculpt” the facial and skull contours — something an implant could never achieve. Particularly in the younger patient, the transplanted fat continues to grow with the recipient over time, maintaining the corrected contours. As transplanted fat has every indication of being permanent, the corrections are long lasting.
Dr. Coleman is associated with the National Foundation for Facial Reconstruction at NYU Medical Center, and enjoys being part of a respected team of surgeons whose goal it is to repair congenital and acquired head and neck deformities. Many of these surgeries may be paid in part by insurance, and our office can help determine if your insurance carrier might cover the costs. Our staff is caring and supportive, and we look forward to working with you.
This 23-year-old patient was discovered to have a rhabdomyoscarcoma of the masseter muscle (a cancer of the muscle on the side of the face used for chewing) when he was eight years old. Therapy with radiation and surgery cured him, but his facial and skull bones did not grow with the rest of his face. He was therefore left with a severely deficient left lower face (see above). Please note the horizontal position of the ear from lack of bony support. In addition the skin was extremely fragile and beard growth abnormal. He had no procedures done since his original cancer surgery.
Between 2004 and now, three Coleman fat graft procedures were performed to arrive at the above result. The fat was layered through tiny incisions using special tools developed by Dr. Coleman over the lower one-quarter of this young man’s face and over the lower part of the skull (mastoid).
The layering started at the bone each time and extended out to the skin. One of the most important reasons for using fat grafts in such situations is that the stem cell and growth factors present in fat grafts may cause healing of the damaged tissues.
Surgeons are hesitant to operate on body areas that have been treated with radiation because they heal poorly or not at all after a surgical procedure. Recent evidence points to the healing of radiation injury and even aging skin by fat grafting to an area. The healing most likely takes place by bringing in stem cells (or repair cells) which build new blood vessels and capillaries to the irradiated skin, muscle and bone.
The fat grafts repaired the hard, friable tissues of the lower face in this man to healthy, soft pliable skin. The fat in this situation feels like bone, muscle, subcutaneous tissue and skin.
One of potentially important reasons for using fat grafts in such wounds is the stem cell and growth factors present in fat grafts. Not only can the structural fat replace the missing fullness, but also there may be a component of accelerated healing mediated by fatty tissue.
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This man had a radical neck dissection for a melanoma 20 years earlier. This left him with not only the obvious deformity, but also left his carotid artery and accompanying structures right below his neck skin. Reconstruction of the jawline and neck was performed in two stages. The patient returned six years after his last fat grafting with not only a more attractive jawline, but also protective covering of the contents of his neck.