The History of Facial Reconstruction
Facial reconstruction is one of the most important fields in modern medicine, and its history stretches back to the 17th century and the work of Gaspare Tagliacozzi. He was the first surgeon to pioneer the technique of restoring facial tissue using skin grafted from other areas, and this has remained as one of the main methods of facial reconstruction following surgery or trauma.
In reconstructive surgery, a ‘like for like’ approach is always taken whereby bone is replaced with bone, skin with skin and muscle with muscle.
The work of the renowned RAF surgeon Sir Archibald McIndoe on burned pilots also used this technique, and while he made great progress in restoring the aesthetic appearance of wounded airmen, he adhered to the maxim that the restoration of facial functions such as the ability to breathe and eat properly should be seen as a priority.
Nicholas Kalavrezos, consultant maxillofacial reconstructive surgeon at the University College Hospital London describes the main tenet of reconstructive surgery as:
“Return what is normal to the normal position and retain it there.”
Whilst this still encompasses the idea of ‘function over form’, modern facial reconstruction acknowledges the severe psychological effect of disfigurement on the patient. The face is seen as a key part of individual identity, and those who have suffered scarring often struggle to resume their role in society following surgery to heal their wounds.
Whilst great steps have been taken in the restoration of both appearance and function with new techniques such as face transplants, there is still some progress to be made in cases where surgery or trauma has resulted in the loss of large areas of the facial structure. The most common cases are where the removal of a cancerous tumour also involves the removal of large areas of surrounding skin, bone and muscle, resulting in a situation where traditional grafting techniques are ineffective.
In these cases, reconstruction aims to restore both form and function through the use of prosthetics. However; this has not always provided an adequate solution, and patients have often struggled to adapt to their prostheses with the psychological impact of their surgery being aggravated by ill-fitting or ill-matching prosthetic implants.
Fortunately, the advent of both 3-D printing and mapping has paved the way for a solution. 3-D mapping uses a scanned image of the patients face to build a picture of the missing portion. This is then used to make an accurate prosthesis using 3-D printing. This technique, coupled with the use of modern synthetic materials, results in a permanent and natural-looking prosthetic reconstruction that also returns normal facial function to the patient.
This should have the effect of helping patients who have undergone severe facial surgery to feel ‘normal’ once again and help them to live fulfilling lives following their procedures.