October 23, 2008
Trauma, burn cases sharpen oculofacial surgeons’ nips and tucks
By Brian Donohue
News & Community Relations
Consider the roughly 35-square-inch area of anatomy that comprises the face. Oculofacial plastic surgeons like A.J. Amadi do, every day. The small but deserving zone includes the brows, eyelids, cheeks and mouth — which together allow people to see clearly and convey expressions integral to communication.
It is no secret that age, sun, heredity and other factors can be unfriendly to skin, which may explain why some 4.5 million people in the United States opted for facial cosmetic procedures in 2007, according to the American Society for Aesthetic Plastic Surgery.
Dr. Amadi and colleague Dr. Robert Tower perform cosmetic nips and tucks and treat facial trauma at Harborview Medical Center, where they staff UW Medicine’s Oculofacial Plastic Surgery Center. They provide brow lifts, eyelid lifts and repair, midface-cheek lifts and injections of dermal filler and Botox.
Oculofacial plastic surgery training and the focus on eye function “make us uniquely suited to serve patients who want purely cosmetic changes,” Amadi suggested. Moreover, Harborview’s Level I trauma center, which bustles with patients from five Northwest states, constantly hones their technique and problem-solving skills.
“We deal with some of the most difficult cases — orbital injuries, burns — and we can apply this experience to cosmetic surgery — recruiting skin in the case of a patient’s cheek lift, suspending facial tissues to provide support for the eyelid, and potentially, harvesting skin grafts to use on the eyelid,” he said.
One such patient was a 19-year-old street acrobat who tried to perform a back flip off a wall. His push-off was weak and he landed face-first in a spray of gravel, tearing off most of his lower left eyelid.
Amadi took a flap from the upper eyelid and rotated it into position below, then grafted adjacent facial tissue on top of that. This approach essentially required closure of the man’s eyelid for a few weeks so the blood vessels could grow and support the transferred tissue.
“Knowing how you can manipulate tissues, how skin is likely to heal and scar — all that comes into play,” Tower said. Lessons in prudence emerge as scars slacken enough with time or a steroid injection so an additional procedure isn’t necessary, after all, he said.
Tower described a not-uncommon injury: A young child approaches the family dog while it’s eating and is bitten on the face by the wary pet. “It can be a pretty severe bite starting at the lower lid near the nose. The whole cheek is dislodged from the child’s face.
“The skills involved in camouflaging that wound translate very nicely in cosmetic cases, because those patients don’t want any telltale signs of surgery, either,” Tower added.
Form and function go hand-in-hand. In the dog-bite case, Tower had to restore the child’s appearance and recannulize the tear drain. In a patient with drooping eyelids, surgeons must recognize whether the eyelid or brow, or both, are appropriate surgery targets, mindful that an overly aggressive correction could compromise the eyelid’s function.
Another experiential insight is the variance of normal anatomy. Research and experience have taught Amadi subtle differences among African-Americans, Asians and Caucasians that dictate varied approaches to eyelid surgery.
“It’s important to have the experience to recognize those subtle differences,” he said. “We know what those variations are and can apply them to our preoperative planning.”
When patients want to feel rejuvenated and look younger, Amadi wants them to know this: “It’s not a cookie-cutter kind of business where everybody gets the same exact procedure. We work with each individual to decide what the specific goals are.”
The surgery center is one component of the UW Medicine Eye Institute, which is slated to open at Harborview’s new Ninth and Jefferson Building next summer.
