Aesthetic considerations following facial reanimation procedures

Abstract

Julia K. Terzis, MD Elliott H. Rose, MD Sydney Coleman, MD Robert L. Walton, MD Dr. Terzis: The first patient is a 24-year-old man with right developmental facial paralysis. He had 3 cross-facial nerve grafts in 1988 and a free-muscle graft in 1990. When he appeared for a follow-up visit in 1991, he was unhappy with his deep nasolabial crease and bulky right cheek. He had slight lagophthalmos in the right eye, but did not complain about that (Figure 1, A). Dr. Rose, how would you address his aesthetic concerns? Figure 1 A, This 24-year-old man has right developmental facial paralysis. After undergoing 3 cross facial nerve grafts in 1988 and free gracilis muscle transplantation in 1990, he was unhappy about the deep crease in his right nasolabial fold and a bulky right cheek. B, The patient is shown 7 years after aggressive debulking of the right cheek and placement of a dermal fat graft through an intraoral incision. A mini tendon graft was used to suspend the right lower eyelid. Dr. Rose: First, he has a beautiful, symmetrical facial reanimation. I have frequently been faced with the problem of a bulky hemi-face, particularly in the zygomatic area of the cheek following free muscle grafts; it presents a particular dilemma. My approach in this patient would be to perform a midfacial advancement through a pre-sideburn incision. I would elevate the right hemi-face and cheek through a face lift plane immediately superficial to the muscle transfer, and very cautiously, under high power magnification, debulk the subcutaneous fat on the surface of the muscle. I would be very hesitant to debulk the muscle itself, since the smile and lateral lip elevation are so symmetrical. Dr. Terzis: How would you deal with the crease? Dr. Rose: I would hesitate to disrupt the crease. By performing …