With the opening of many specialized burn centers for acute burn injuries, death rates from severe burns have dropped significantly. Survivors, however, are often left not only with functional impairment (e.g., drooling, neck contracture, corneal exposure, nasal airway blockage, lip incompetence), but with grotesque facial appearances and distorted facial expressions. Once survival is assured and acute vital life functions are satisfied, the question most often asked by burn victims is, “doc, when am I going to look normal again?”
The focus of Dr. Rose’s clinical experience over the past 20 years has been directed toward refinement of aesthetic appearance, as well as improvement of functional limitations in severely burned patients. Skin grafts are used by conventional plastic surgeons to replace burn-damaged skin. The grafted skin (only a few cell layers thick) often leaves a “patchwork,” expressionless face. The skin texture is ropey, thickened and irregular, the face lacks animation. Dr. Rose, the author of the highly-regarded plastic surgery textbook, Aesthetic Facial Restoration (published by Lippincott-Raven), has refined the newest methods of burn reconstruction utilizing sophisticated computer imaging, the latest methods of micro-surgical tissue transfers, intra-operative skin expanders, laser technology, and custom corrective make-up matches to achieve the most complimentary surgical outcome.
Your initial consultation
At the time of your initial consultation, Dr. Rose will review your history, discuss your burn deformities, and design a comprehensive treatment plan. A computerized facial analysis enables detailed inspection of facial features for balance, symmetry and functional distortions. Areas of disfiguring scar are defined and a video image of your more normal-appearing face is digitally recreated as a preview of the desired surgical changes. These images become the “blueprint” for surgical reconstruction.
Nancy Slifer, our Patient Coordinator, assists our out-of-town patients with hotel accommodations, travel arrangements, etc. As a courtesy, Dr. Rose will write a comprehensive letter to your insurance carrier describing the surgical plan and request pre-determination for medically necessary services. Linda Ossias, Practice Administrator, handles administrative and insurance matters and is available to help in any way she can. We do not belong to Medicare, Medicaid, or any managed care plans, but we lobby for you to achieve maximal reimbursement from your insurance carrier as long as out of network coverage is available. In some instances, the insurance companies will approve “in network” coverage to allow for Dr Rose’s expertise as a non-plan surgeon.
Major facial reconstructive surgery is performed at The Mount Sinai Medical Center in New York City—a world-class teaching hospital and “center of excellence” for restorative burn surgery. During surgery, thick scars, known as keloids, are removed and replaced microsurgically with patterned blocks of tissue harvested from inconspicuous donor sites (back, forearm, scalp, etc. Thick tendon-like tissue from the thigh is used like “internal suspenders” to support a more normal balance to the lips, cheeks, and nose. The tailored blocks of tissue, comprised of skin, fat and blood vessels, are inset like a “pieces of a puzzle” into the new facial unit (e.g., chin, neck, lip, cheek, etc.), and circulation is immediately restored by delicate attachment to the facial artery. The newly defined facial tissue is “sculpted” to look, feel and behave like a normal facial skin, with scars hidden in the shadows of the facial planes.
In less complex cases, facial, extremity, or torso burn scars can be eliminated or camouflaged by the clever use of a variety of techniques including scar revision, internal slings, skin grafting, intra-operative tissue expanders, and laser resurfacing—all with the goal of achieving the most aesthetically pleasing result.
In most cases, you will resume normal activities within 2-4 weeks from your surgery date. After surgery, you will be referred to a skilled make-up artist who will teach you cosmetic camouflage techniques to hide incision sites and color imperfections. A flesh-colored concealer is custom blended as a foundation to blend facial tone properly (as in above photos). In some instances, medical tattooing is used to pigment facial features (e.g., lip eyebrow, beard).
What to Expect? Although disfiguring burn scars cannot be “erased” in their entirety, cosmetic appearance and functionality can be greatly improved.