Facial reconstructive surgery in Paris

01Facial reconstructive surgery

Facial reconstructive surgery can be performed in many very different situations:

• Skin cancers, 
• Birth malformations: malformations of the face and skull are numerous and generally result from abnormalities in the development of the embryo (problems with the growth of the face, skin, muscles, bones, etc.). Malformations such as Treacher Collins syndrome, Franceschetti syndrome or Nager syndrome cause developmental problems of the eyelids, cheekbones or jaw. Facial reconstruction is then carried out as part of multidisciplinary care alongside ENT specialists, maxillofacial surgeons or orthodontists.
• Tumours: these appear as a lump that is sometimes present from birth, arising from a facial bone (jaw, orbits) or from soft tissue (skin, muscles). Most often benign, they can nevertheless sometimes prove malignant and require radiotherapy or chemotherapy before or after removal (when removal is possible), depending on the case and the diagnosis. The tumour may be only partially removed if its removal would endanger the patient.
• Accidents: certain domestic accidents or road accidents can completely disfigure the face after an impact or following a house or car fire. Facial reconstructive surgery also makes facial reconstruction possible to improve the lives of severe burn victims or severely injured patients.
• Bites: animal bites, mainly from dogs, can disfigure a face (nose, lips or ears partially or completely torn off). Reconstructive surgery makes it possible to rebuild these destroyed parts of the face, often after several procedures.

These facial reconstruction procedures require several preliminary consultations with a surgeon. The surgeon’s diagnosis makes it possible, depending on the case, to set up a treatment protocol. This reconstructive surgery will often require several operations, with procedure durations that can be quite long (from 1 hour to 8 hours depending on the type of procedure). The recovery and post-operative recovery will also differ according to the patient’s profile and the type of surgery planned.

02Facial reconstruction after cancer in Paris

While the most common facial tumour is benign (a naevus, more commonly called a mole), it can nevertheless change, become malignant and then present a risk of progressing to cancer. The other facial tumours, on the other hand, must be monitored particularly closely and can prove cancerous, with varying degrees of severity ranging from basal cell carcinoma to squamous cell carcinoma and even melanoma.

Facial reconstruction following cancer can take place either after the removal of the cutaneous tumour, the carcinoma or the melanoma (after histopathological analysis) or during the same operation. The surgery removes the lesion in full with a healthy-skin safety margin, and the specimen is systematically analysed under the microscope (histopathological examination) to confirm that the margins are clear. For facial carcinomas located in delicate areas (nose, eyelids, ear), Mohs surgery — a histological margin check carried out layer by layer during the procedure — offers a very high cure rate while preserving as much healthy skin as possible, for an all the more discreet reconstruction. The after-effects left by a skin cancer may require reconstruction in various parts of the face (reconstruction of the nose, reconstruction of the cheeks, around the eyes or around the ear). Facial reconstruction is then carried out mainly using 3 techniques:

• Direct closure with sutures after the removal, when this is possible and does not cause too great a loss of substance.
• The skin graft: the operation consists of filling the loss of substance with a skin graft taken from other parts of the body (often from the neck or the area around the ear). This technique helps to limit the deformity of the area affected by the tumour. It also makes it easier to monitor this area in the case of a lesion at high risk of recurrence. The main drawback lies in the skin texture, which is sometimes different between the donor area and the graft area, sometimes causing a « patch effect ». The graft may also fail to take on the first attempt and require a second procedure.
• The use of local flaps or plasties: tissue flaps located close to the area undergoing a loss of substance are used to close the skin, in particular by rotating it. The choice of reconstruction will depend not only on the surgeon’s diagnosis but will also be considered in light of the treatment planned to deal with the tumour, as well as the practicality of the chosen solution for monitoring recurrences.

03Reconstructive surgery after burns / scars

A scar can never truly disappear completely, despite all the modern methods of surgery (laser, chemical peel, creams). Reconstructive surgery does, however, make it possible to greatly reduce the appearance of a problematic scar — that is, a normal scar following more or less significant trauma.

The types of treatable scars and burns:

Reconstructive surgery must be performed on mature scars, that is, scars more than 6 months old after the wound, cut or abrasion. The after-effects of burns also cause a major cosmetic concern and can be treated one year after they appear. Reconstructive surgery makes it possible to treat the following scars:

• Contractile scars: hard or curled-up scars with very little flexibility, which are almost impossible to stretch.
• Ulcerated scars: scars whose fragility causes regular grazes and abrasions that can then deepen. These slight tears in the skin, which never fully heal, can then prove problematic and, in some cases, serious.
• Unstable scars: old scars, sometimes even ones that have become invisible, presenting a risk of malignant degeneration.
• Hypertrophic scars: these are scars with a swollen, raised appearance and a strong tendency to inflammation and swelling, which recur regularly. They then turn red/pink. Their abnormally large volume causes pain.
• Unattractive or unsightly scars: scars whose unsightly visual appearance can be bothersome and a source of self-consciousness in daily life (hollowed, irregular, sunken, discoloured, widened, adherent scars, etc.).

The techniques for treating scars and burns:

Depending on the case, different techniques may be used to minimise scars or burns:

• Dermabrasion: this consists of removing the superficial layer of the face (the epidermis) using a rotating brush (microdermabrasion) or a laser (ablative or non-ablative). This technique is particularly effective for sunken scars, including acne scars.
• Serial excision: excision of defective scars in several stages to allow the scar to relax.
• The skin graft (full-thickness skin graft or split-thickness skin graft): a graft of skin tissue taken from other parts of the body, in particular to fill a hollow or to replace burnt areas of skin.
• Local plasty: moving a portion of the skin near the scar to cover it.
• Skin expansion or skin stretching, in which inflatable balloons are placed under the healthy skin adjacent to the defective scar or the burn so that the skin stretches and can cover the scarred area or the burnt area.
• Scar lipofilling: injection of autologous fat cells to correct the texture of the skin adjacent to the scar.
• Flaps: as with tumours, transferring the skin neighbouring the burnt tissue makes it possible to interpose an area of « healthy » skin across the burnt area.

These techniques make it possible to give a new appearance to the scarred or burnt skin and to considerably reduce the resulting cosmetic concern. Skin grafts can, in certain cases, qualify for insurance coverage by the French national health insurance.

04How the procedure works

05Prices & fees in Paris

Indicative “from” prices, surgeon fees included. The final quote is given at the consultation, after examination, depending on the area treated and the technique chosen. Part of the procedure may be covered by French national health insurance when the medical criteria are met.

06Your questions