Complex facial reconstruction with invasive and non-invasive conventional interventions

Abstract

Background: Despite the obvious advantages, face transplantation requires strict patient selection to guarantee optimal outcomes. Therefore, it is not suitable for all patients with severe facial disfigurements. Simultaneously, conventional plastic and reconstructive surgery techniques, as well as medical spa techniques, have evolved, offering minimally invasive treatment of complex deformities.

Methods: The entire face of a young woman was severely disfigured because of a mistreated juvenile acne, with severe ectropions, oral incompetence and substantial midfacial tissue defect. We are describing the reconstruction with a combination of conventional reconstructive methods, such as scar release, skin transplantation, local flaps, medical needling and lipofilling.

Results: Oral competence, unhindered breathing and adequate lid closure was achieved. Previously unable to participate in social life in any meaningful way, our patient was able to reintegrate fully and take a job.

Conclusion: For selected patients, combined, invasive and non-invasive conventional techniques can provide satisfying outcomes in complex facial reconstruction. Modern regenerative approaches such as lipofilling and medical needling should be considered as integral parts of treatment strategies.

Keywords: Face transplantation; Facial disfigurement; Vascularized composite allotransplantation.

Figure 1

(a, b) Severe tissue loss including lips, oral vestibulum, nose and extended ectropium on both eyes. A severe juvenile acne of the face had been treated in a nonmedical lay by tape occlusion of the necrotizing pustulas leading to a severe necrosis of the central face. The soft tissue and skin of the residual face and forehead was scarred and fibrosed limiting reconstruction by local tissue.

Figure 2

Near total face reconstruction by conventional and regenerative techniques. In the first step release of fibrotic scars around the ectropionized oral mucosa (a) and the eyelids enabled reconstitution of the oral vestibulum and conjunctica by multiple abdominal full thickness skin grafts (b–d). Nose soft tissue was reconstructed by a Washio flap and rib cartilage grafts as a forehead flap was not possible to raise due to excessive scarring (e).

Figure 3

To enhance the residual scars and correct for volume deficits multiple lipofillings were applied to the reconstructed periorally (a) and nose (b) as depicted two months postoperatively.

Figure 4

Additionally medical needling was used for the total face to improve texture (a). Adequate functional outcome of eye and mouth closure was achieved (b). Full rehabilitation with aesthetic appearance allowing to work in public (c).