02-22-2023 Primetime Living - Flipbook - Page 16
16 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, February 22, 2023
FACIAL CARE
A more
functional face
Advances in facial paralysis care
to bring smiles back
By Linda L. Esterson, Contributing Writer
E
very face tells a story, and with new advances in facial plastic surgery, people no longer need to hide their scars from
past traumas.
Facial abnormalities can occur for a
variety of reasons, including Bell’s palsy or
another viral infection; damage from and
removal of head, neck and skin cancer; and
trauma caused by animal bites, knife or gunshot wounds, or car accidents.
“People care about how they look and
how they’re perceived,” says Dr. Natalie
Justicz, assistant professor of otorhinolaryngology - head & neck surgery and facial plastic & reconstructive surgeon at the University
of Maryland. “The face is the main way they
interact with the world.”
Treatments depend on the level of nerve
activity that results following trauma.
Facial paralysis
Facial paralysis can occur as a result of
a viral infection like Bell’s palsy or a stroke
or brain tumor. Initial symptoms of a facial
nerve disorder include facial paralysis on
one side, facial drooping and/or numbness,
drooling, ear pain, and altered speech. If
these symptoms accompany severe headache, seizure or blindness, seek emergency
care immediately.
Following a diagnosis of Bell’s palsy,
Ramsay Hunt syndrome, and even Lyme
disease, patients with these symptoms are
advised to follow up with a board-certified
facial plastic surgeon or ENT who can determine the best course of treatment.
After Bell’s palsy, a lack of movement or
control in an area of the face is often caused
by synkinesis or cross wiring of the facial
muscles. Cross wiring is evident when the
nerve regenerates and the individual tries
to blink the eye but the corner of the mouth
curves or when an attempt is made to smile
and the eye on that side slams shut. Often
the preferred treatment methods are medical Botox, a neurotoxin that paralyzes the
muscles, or newer techniques like selective
neurectomy, which involves surgical clipping
of the cross-wired nerves.
When paralysis occurs as a result of a
trauma, like a gunshot or knife wound, a
car accident, stroke or tumor surgery, and
function does not return, more complex
treatment is indicated. Patients may need
nerve transposition surgery, which involves
taking part of the chewing muscle or tongue
nerves to connect to the facial nerve in order
to restore function. Nerves may also be used
from other parts of the body for grafting.
In some cases, a gracilis muscle transfer
may be necessary. This involves transferring a muscle unit from the leg to the face to
restore the smile.
Post-Mohs surgery
Reconstruction is often specified to
restore function and appearance following
an in-office dermatology procedure or head
and neck surgery to remove cancer from the
forehead; near the eye or lip; on the cheek or
ear; or most commonly, on the nose.
According to Justicz, various options
exist for these high-impact areas. The nose,
she says, is particularly challenging due to
its curvature. Justicz meets with patients to
discuss skin grafts, cartilage support or a
paramedian forehead flap, in which a flap of
forehead skin is flipped down to the nose to
provide local tissue to cover the large area.
After three weeks of growth including the
formation of new blood vessels, the skin is
divided and permanently attached. Another
type of flap that is sometimes utilized is the
melolabial flap, which involves tissue from
the fold between the cheek and lip.
Scar revision
Facial scars occur as a result of injuries
from accidents, dog bites and other traumas, as well as from surgeries. They may be
minimized or camouflaged using a variety of
techniques.
A common choice for scar revision is
laser correction. There are several types that
can be used. The BBL laser is used for scars
that are red in color, and up to three treatments may be needed. The ProFractional
laser creates a deeper line to correct contour
irregularities that don’t respond completely
to fillers. Geometric broken line closure, or
Z-plasty, breaks up long scars to make them
appear more natural. This technique is used
to hide scars within natural concavity and
convexity.
“Lasers and surgical instrumentation are
constantly improving, and new techniques
are in development,” Justicz explains. “It’s
always worth checking to see if something
can be done even years later. You don’t have
to have a mark on your face forever.”
Visit umfpi.org/fps to learn more
about surgical and non-surgical options
to treat facial nerve disorders and other
facial concerns.