Procedures offered include: skin cancer reconstruction, facial paralysis corrective surgery, facial trauma surgery, scar revision, microvascular reconstruction.
Skin Cancer Reconstruction
Working in concert with Dermatologic Mohs Surgeons and Head and Neck Cancer Surgeons, Dr. Sand helps provide reconstruction for skin cancer defects of the head and neck. As a face expert, Dr. Sand attempts to make sure that any skin cancer related defect is reconstructed following aesthetic and functional principles to achieve as natural a result as possible.
Facial Paralysis Corrective Surgery
Facial expressions are often taken for granted until there is noted asymmetry in appearance. When we interact with each other, smiling and many other facial expressions are critical to communication. With a facial paralysis, a patient finds a sudden change in the ability to close the eye, speak, swallow or even breath through the nose. The goal of corrective surgery for facial paralysis is to attempt to restore meaningful and expressive movement of the face. The eyes are addressed by lifting the brow, helping restore eyelid closure, and tighten the eyelid. The midface and mouth are addressed by opening the nostril, lifting cheek tissues, and restoring the smile with muscle or nerve transfers if available.
The following procedures are provided:
Nerve repair or nerve grafting
If the facial nerve is damaged, an attempt to sew the nerve directly together under magnification will be made. However, if a gap exists, a donor nerve from the neck or an extremity may be needed to bridge the two nerve endings.
Correction of the eyelid and eyebrow
A platinum weight in the upper eyelid can be used to help restore closure. A lower lid tightening procedure is performed to prevent exposure of the conjunctiva. A browlift is performed to prevent eyelid ptosis and restore symmetry.
Temporalis tendon transfer
The temporalis tendon connects the temporalis muscle to the jaw. Orthodromic transposition of this tendon to the corner of the mouth can restore movement to the lips without significantly altering the facial shape.
Nerve substitute grafting
This procedure involves transferring another nerve of the head and neck to the facial nerve to allow for restoration of muscle tone and movement to the paralyzed side. This may occur by a cranial nerve 5-7 transfer or 12-7 transfer.
Restoration of facial contour
Facial paralysis is often a side effect of a larger surgery and may impact facial contour. Fat grafting or free tissue transfer with microvascular anastomosis may be a part of the treatment plan.
Face or neck lifting
To provide resting symmetry to the face, a facelift or necklift may be needed.
These injections may be used to treat synkinesis or to restore symmetry by weakening the non-paralyzed side of the face.
Facial Trauma Surgery
Injuries to the facial soft tissue or skeleton can happen from a variety of mechanisms including a motor vehicle accident or a fall. These injuries may require a multilayered soft tissue closure, closed or open reduction of the facial bony fractures or possibly implanted hardware to keep the facial fractures aligned. Each of these would be determined based on the type and severity of the injury.
Previous surgery, trauma or injury to the skin can leave individuals with facial scars that are unsightly or unwanted. Dr. Sand has a variety of tools that can help decrease the impact of the scar, improve the quality of the scar, or change its alignment to make it less noticeable. Each situation is unique and the individualized treatment plan would be discussed during your consultation.
Microvascular reconstruction is a technically demanding procedure in which tissue grafts of skin, fat or bone are harvested from the arms, legs, abdomen or back and transferred to the mouth, throat or face to replace missing tissues. The blood supply is restored by anastomosis of head and neck vessels to the transplanted tissue performed under high magnification. Dr. Sand has extensive experience with this state-of-the-art reconstructive surgical method and performs these surgeries in tandem with his partners at Columbia Surgical Specialists.