Summer 1997 Mission

Surgeons recreate facial features


"Plastic surgery is a marriage between beauty and blood supply, and it's about solving problems," said Jaime R. Garza, MD, DDS, clinical assistant professor and division head of plastic and reconstructive surgery at the Health Science Center. "We take care of the individual patient's needs and try to make each surgery functional and aesthetic. That's what it's all about; that's the challenge. I love what I do!"

To illustrate some of the challenges, Dr. Garza relayed the story of a cancer patient. "After we'd completed the cancer surgery, she'd lost a third of her upper eyelid plus her entire lower eyelid, all the way down to the bone, leaving her eye exposed. She then had a large defect because, in the end, the entire periorbital complex (eye socket) had to be removed. We used palatal mucosa (membrane covering the palate) from inside her mouth and tissue from her nose to recreate the inner lining of her eyelid.

"We had to then make a long incision in her neck and cheek," Dr. Garza continued, "to move tissue from this area and position it around her eye, then we sutured the entire thing in the natural crease lines so the scars wouldn't be obvious. Once we had finished, the lady had a new lower eyelid. She could open and close both eyes."

Another patient had a small skin lesion on the tip of his nose shaved by a dermatologist. A biopsy showed it was malignant. "The Moh dermatologist (one who uses the technique developed by surgeon Edward Moh) has special training; he shaves the margins only a little at a time," said Dr. Garza. "He knows exactly how far to go to remove any cancer cells. He removes some tissue, which is reviewed to see if any malignant cells are remaining."

As a result of the surgery to remove the lesion, the patient's nasal skeleton, including the cartilage, had been exposed. The plastic surgeons then had the challenge of covering the nose with skin from another part of his body. (See photo series.)

"The face is an aesthetic unit with all these associated subunits. The dorsum (side) of the nose is one subunit; the tip of the nose is another," said Dr. Garza. "The secret is to make incisions along the natural crease lines to camouflage the scars. Then after surgery, when you glance at the patient, all that's noticeable are natural contours and shadows. Any incision made outside the natural crease lines or contours will be obvious; your eyes will focus on it immediately.

"So when we reconstruct with a skin flap," the surgeon explained, "we need to rebuild the entire aesthetic unit, not just the small portion that has been affected. That way, the scars are hidden."

Plastic surgeons try to match skin that has been removed with skin from another area of the body. "In this case we made a template and drew it out of the top of the forehead, since there is a blood vessel running right through the center of it, and carried the whole thing down to cover the man's nose. The area that has been transplanted becomes parasitic—it's now receiving its blood supply from the area where it has been transplanted," said Dr. Garza. "After the swelling goes away and the scars heal—in two or three weeks—the surgical incisions will be well disguised."

Using skin and tissue from other areas of the patient's body eliminates any possibility of rejection. "The body doesn't recognize that new tissue has been transplanted from another area nor that it doesn't belong there," said Dr. Garza.

Joel E. Pessa, MD, clinical assistant professor and director of plastic and reconstructive surgery's cleft palate unit, frequently teams with Dr. Garza. His interest in pediatric plastic surgery recently prompted him to travel to Mexico City where he learned a surgical technique for creating a new jawbone—distraction osteogenesis. "So now when a child is born with only half a jawbone, it's possible to rebuild his face. I've seen more children in this center with that problem than anyplace else in the United States," Dr. Pessa said. "A tremendous number of kids in the Lower Rio Grande Valley have congenital deformities."

The procedure requires incisions of the mouth and jawbone. After the incisions are made an appliance is attached to both sides of the separated bone to maintain the separation or distraction. New bone grows on the ends of the incised jawbone. The Health Science Center is the only Texas site to offer this procedure.

"I'm very proud of this university," he continued. "We do top-notch plastic and reconstructive surgery here, across the board. I'm proud of this institution for taking care of these children, and for using this type of technology, and for using all its services to help these kids. The surgery that's done on these children requires a whole group of people—a plastic and maxillofacial surgeon, frequently a neurosurgeon, and Dr. Mark Pigno, in maxillofacial prosthetics, is involved.

"In terms of what we can offer at the Health Science Center," said Dr. Pessa, "it takes the entire group, working together, with Jaime Garza! He's spectacular—as good as anybody in the country.

"It's nice to be able to take somebody who can't walk down the street without being stared at and make him look normal. Not beautiful, just normal!" concluded Dr. Pessa. "Now he can wake up in the morning and feel like he fits in—that's a service, a real gift, and our team can do that!"

Just another face in the crowd
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