Holger G. Gassner, M.D., Board Certified Facial Plastic Surgeon (USA)


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FACIAL DEFECTS

Defects of the face are oftentimes the result of a skin tumor removal or an accident.  Depending upon the severity of each case, the restoration of these soft tissue defects can vary widely.  During reconstruction, the lost tissue is replaced by new tissue which is as similar as possible to the original tissue in as many factors as possible.

Facial reconstructive surgeries may be necessary after accidents or surgical removal of skin cancer, or due to birth defects all of which represent a special challenge in correcting. Different aspects of the anatomy of the face must be reconstructed in the best possible way in order to achieve a satisfactory result.  These aspects include: three-dimensional contour of the bony cartilaginous skeleton, the thickness and consistency of the layer of the overlying tissue as well as the color, texture and surface texture of the facial skin. Each of these considerations must be included in the analysis before the treatment and can influence the optimal choice of the reconstructive method.

For complex defects, e.g. partial or complete defects of the nose and the ear usually require several operative steps and the entire treatment may take several months. Close cooperation with colleagues in other disciplines such as Dermatology, MKG surgery, Opthalmology and and other plastic surgery is often necessary and ensures that the patient optimally benefits from the knowledge within each individual discipline.

Restoring defects of the nose can be particularly challenging. Prof. Gassner is regarded as an international expert in the reconstruction of nasal defects and was the first to describe the technique of pre-fabrication of a forehead flap with skin grafts.   This technique allows a particularly effective and gentle restoration of the inner lining of the nose.  This technique was adopted by several centers, the John’s Hopkins Medican Center in the USA among them.

One may distinguish defects that are limited to the external skin and more complex defects that include the structure of the nose such as bone and cartilage and the internal lining of the nose. Depending on the complexity of the defect, the reconstruction may require multiple surgical stages which are typically performed a few weeks apart. In some instances the skin of the nose maybe replaced with a flap of forehead skin. Bone and cartilage of the nasal skeleton maybe replaced with cartilage harvested from the ear or from the rib.

Harvest of cartilage from the ear is performed through an incision behind the ear.  Only those parts of the ear cartilage are removed that have no influence on the external shape of the ear.  Sometimes an additional tissue maybe harvested through the same incision.  The harvest of rib cartilage is typically performed through an incision in the fold below the breast in females.  In males this incision is placed a little lower on the chest.

Restoration of the nose may take up to 12 weeks depending upon the severity of the defect. In the case of total defects of the nose, generally, 4 operations are carried out approximately 3 weeks apart. Restoration surgury can often begin soon after the incident that caused the defect, happened. For example, if no radiation treatment is necessary after removal of a basal cell cancer, the first restoration operation can be scheduled about one week after removal of the tumor. An unconditional prerequisite is the safe removal of the tumor in healthy tissue. Professor Gassner attaches great importance to the fact that this is clearly evident from the final histology. Often, incisions are made to create additional margins for the healthy tissue to achieve the greatest possible ensurance the basal cell affected areas are absent.

The patient can spend the time between the individual restorative operations at home.  The average duration of the stay in hospital directly after a restoration operation is 2 to 4 nights.

When the use of a forehead flap becomes necessary, Professor Gassner prefers the so-called secondary wound healing.  The resulting defect on the forehead heals from the inside.  After a few months, the sensitive spot is usually completely epithelialized.  In the remaining months, the wound usually heals so that the color and texture of the skin is a better match than with other methods.  After a period of 2 years at the latest, the resulting scar is hardly visible on the forehead.  In the intervening healing phase, color differences can be made almost completely  unnoticable with make-up.

For examples of nasal reconstructions, see the Before – After link. We would be glad to send you a copy of Professor Gassner’s article on nasal reconstruction.  Please send your request via the Contact link. If you would like to become in contact with patients who have been operated on by Prof. Gassner regarding these types of reconstructions, please send us a corresponding message.

The restoration of the auricle ranges from the reconstruction of minor defects up to a  complete Otoplasty. All parts of the auricle (earlobe, auditory canal, auricle) may be affected; techniques for restoration exist for all parts of the ear. For the replacement of structural parts, the removal and transplantation of ear or rib cartilage can be necessary. Generally, the procedures are carried out on an outpatient basis and under local anesthesia.  More complex interventions can also require a procedure involving several steps and, if necessary, general anesthesia.