About Dr. Tollefson

Travis T Tollefson MD, MPH, FACS, is the Director of Facial Plastic & Reconstructive Surgery at UC Davis, where he and his team offer excellence in the full spectrum of pediatric and adult facial reconstruction and aesthetic surgery. As Co-director of the UC Davis Cleft and Craniofacial Program, he also provides surgical care for children and adults with cleft lip and palate, microtia, or head and neck vascular anomalies. Dr Tollefson enjoys the challenges of rhinoplasty and revision rhinoplasty, whether the patient is seeking improved nasal function, nasal appearance, or both. He recently co-chaired the clinical practice guidelines on rhinoplasty and is a strong patient advocate for his rhinoplasty patients.

Patient Education Emphasis

Dr. Tollefson is dedicated to providing the best possible educational experience so that each patient is fully involved in the decision-making process. Some patients take advantage of the clinic’s latest technologies during consultation, including 3D facial analysis using an automated stereophotogrammetry system, educational offerings on iPad’s in the clinic to inform patients about the patient’s problem, the potential treatment options, and the alternatives.

Non-surgical techniques

Dr. Tollefson and his team also specialize in non-surgical techniques to help you look your best at any age. To meet the needs of some patients, a surgical procedure is not always necessary. Non-surgical options are available such as laser skin treatments, dermabrasion, facial fillers, and Botox injections.

From Start to Finish

Whether you have always wanted to change the shape or function of your nose with a rhinoplasty, or have had a facial skin cancer removal (Mohs surgery) from your face, Dr. Tollefson emphasizes patient education and support for patients and their families for both surgical and non-surgical procedures. From the moment you step in to our clinic we hope you will ask questions and consider us partners in your care. Both Dr. Tollefson and his extraordinary nursing team to help guide you through your assessment, presurgical preparation, surgery and aftercare, or non-surgical procedure to achieve your best results.

To schedule a consultation, please call (916) 734-2347

The care process starts as early meeting prenatal counseling with expecting parents who have been advised that by Perinatology or Maternal- Fetal Medicine Team that a perinatal ultrasound shows a possible cleft lip or palate. I believe that by offering support and setting goals, parents can feel more empowered and ready for their new child. All of our care at UC Davis Children’s Hospital is performed as a team of dedicated pediatric specialists offering comprehensive cleft lip, cleft palate and craniofacial evaluations, state-of-the-art surgical procedures, specialized speech and feeding studies, hearing evaluation and treatment, feeding/nutritional assessment, dental, orthodontic and maxillofacial surgery evaluation and treatment, and genetic counseling.)
Naso-alveolar Molding is completed by Dr Tollefson and a specialized cleft orthodontist. A newborn child with a wide cleft lip can have a dental appliance made and adjusted with biweekly appointments to improve the severity of the cleft before.
Dr Tollefson specializes in the meticulous repair of a child with a cleft lip . “If I could do one thing everyday for the rest of my life, I would want to repair cleft lips. It is the perfect blend of needing a grasp of the challenging anatomy and an artistic eye.”
Caring for an infant with a bilateral cleft lip and palate is so rewarding. Dr Tollefson and his team help parents with feeding issues,Nasoalveolar molding, and the surgical repair of the cleft lip and palate . The next few years include evaluation and treatment of hearing, speech, dental, and orthodontic care. After the child is fully grown, orthognathic surgery and cleft rhinoplasty is offered.
Dr Tollefson treats an infant with a cleft palate between 10-14 months of age using a variety of the most modern techniques.
Dr. Tollefson offers each of the traditional and latest secondary speech surgeries for children with cleft palate, which includes but is not limited to pharyngeal flap, palate lengthening with Furlow palatoplasty, and sphincter pharyngoplasty. If you notice that your child’s speech sounds nasal, it can mean that Velopharyngeal dysfunction (VPD) is present and you should seek a consultation.
  • A child with a cleft palate will most often have surgical repair around 1 year of age.
  • The goals of the surgery are to realign the speech and swallow muscles and repair the palate.
  • For the next few years, most children will benefit from specialized speech therapy and some (approximately 15-25%) will require a secondary speech surgery.
  • These speech surgeries are typically considered after the child is 4-5 years old, so that they can cooperate fully with the Velopharyngeal Dysfunction (VPD) workup. (link to ACPA speech patient info webpage)
  • The VPD workup gathers information about the child’s speech,the amount of nasal air escape and hypernasality with phonation .
  • We are very interested in the overall effects of the child’s ability to communicate.
  • Overall, the child’s intelligibility can cause difficulties with speaking with friends, at school, and with family.
  • We believe in learning more about how this can affect the quality of life of both the child and their family. We collect a short survey (VELO) on all of our patients so that we can better address their needs. We have also developed a Spanish language VELO to meet the needs of our patient population.
  • If Dr Tollefson and his specialized speech-language-pathologist determine that a speech surgery is warranted, we promote a shared decision-making process with parents.
  • A child with a cleft palate will most often have surgical repair around 1 year of age.
  • A child with a cleft palate will most often have surgical repair around 1 year of age.
The velopharynx is a space in the back of the nose that connects to the back of the mouth. This area between the soft palate and back wall of the throat must close properly to avoid air escaping out the nose during speech (or food and liquids during swallowing). Adequate closure is also necessary for creating interpretable speech and oronasal resonance. VPD can be caused by a lack of muscle movement or soft palate size. The goal is for complete closure is coordinated muscle movement in the soft palate and sides of the back of the throat (lateral and posterior pharyngeal walls. ) The inability to close the velopharyngeal sphincter , thus letting air leak outof the nose the production of oral sounds of speech is VPI. This causes hypernasal speech which is then evaluated with a VPD workup.Is that different from Velopharyngeal insufficiency (VPI)?Not really. Some specialists use either VPI or VPD interchangeably.
One of the most commonly used surgical interventions to treat VPD is the pharyngeal flap. The goal of a successful pharyngeal flap is to partially block the nose off from the mouth so that air can pass for breathing but can be closed off for speech. The surgery is performed by making incisions in the back of the throat and creating a tissue flap that i5s attached to the back of the soft palate with sutures. This bridge then heals into place and the sutures dissolve. A view of a pharyngeal flap seen with a scope through the nose is shown . Often this surgery is chosen during the VPD workup if the soft palate is not touching the back of the throat (a gap in the posterior pharynx), and the side walls are moving really well.
Surgery to lengthen the palate involves a procedure described by a surgeon named Furlow, which has been coined the double opposing Z-plasty palatoplasty. This revision palate surgery is completed to reposition the muscles of the soft palate and to use a Z-shaped pattern to the incisions, which can add length to the palate and allow it to better touch the back of the throat.
Similar to a pharyngeal flap, the space in the back of the throat (velopharyngeal space) is changed to prevent air escape with a sphincter pharyngoplasty. This procedure moves two small flaps of tissue to the back of the throat. The tissue flaps are from the “pillar” from behind the tonsils ( or where they used to be for children who have had tonsils removed). Often this procedure is chosen after the VPD workup if the soft palate is moving backwards well but the sides of the throat are not moving well.
One of the surgeries listed above may not be necessary if only a small gap is noted during the VPD workup. Air escape from the nose may be treated by injecting a filler material or the patient’s own fat into the back wall of the throat, although the permanence of these outcomes is not yet well studied.
A child with a cleft lip and palate will meet with an orthodontist prior to the permanent canine teeth coming in (erupting). The orthodontist will possibly use a maxillary expansion device to widen the upper jaw and straighten the teeth. Dr Tollefson will then place a bone graft from the child’s hip bone into the bone gap in the gums (called an alveolar bone graft from the iliac crest)
Dr Tollefson respects the challenge of a revision rhinoplasty surgery and thoroughly enjoys creating a plan to address the patients concerns. Rhinoplasty for a cleft lip nasal deformity is likely the most complicated and post-operative results can show dramatic improvement.
Patients with a cleft lip will often describe the way that they feel about the scar on the lip. Dr Tollefson offers treatment to make these scars as imperceptible as possible.
Dr Tollefson works with a team of expert oral surgeons to change the shape of the upper and lower jaws (called orthognathic surgery ). These surgeries can be very effective at changing the way the teeth line up, improve a patient’s breathing, and improve the appearance and balance of face.
Occasionally, a baby is born with a small jaw and tongue that obstructs breathing. These infants may have Pierre Robin Sequence and require a jaw surgery to improve their breathing and swallowing. Distraction osteogenesis is a surgical procedure in which metal pins are inserted (either internally or externally) and then activated to elongate the jawbone. Dr Tollefson and his partner have been successfully using distraction osteogenesis for over a decade.

Repair of facial cancer defects that have been created using the Mohs technique often utilize healthy adjacent skin flaps or skin grafts. Large facial cancers occasionally need to be repaired using free tissue transfer, ie skin, muscle, and/or bone from a different part of the body brought to fill the facial defect.

How to Prepare for Rhinoplasty Surgery
Nasal surgery can correct functional breathing problems (septoplasty) and the aesthetic appearance of the nose (rhinoplasty). Reshaping the nose requires careful attention to facial balance and proportion, resulting in a nose that looks natural and in proportional balance with other facial features. Creating this balance is an art and can significantly enhance facial appearance. Rhinoplasty is often performed under local anesthesia with minimal time off from work.

The Surgery
First, incisions are made and the bone and cartilage support system of the nose is accessed. The majority of incisions are made inside the nose, where they are invisible. In some cases, an incision is made in the area of skin separating the nostrils. Next certain amounts of underlying bone and cartilage are removed, added to, or rearranged to provide a newly shaped structure. For example, when the tip of the nose is too large, the cartilage area is sculpted to reduce size. The angle of the nose in relation to the upper lip can be altered for a more youthful look or to correct a distortion.
The tissues are then redraped over the new frame and the incisions are closed. A splint is applied to the outside of the nose to help retain a new ship while the nose heals. Soft, absorbent material may be used inside the nose to maintain stability along the dividing wall of the air passage called the septum. Alternatively, soft nasal support that permit nasal breathing post-operatively can be placed. Risk factors in rhinoplasty are generally minor.

Post Surgery
Immediately after surgery, a small splint will be placed on your nose to protect it and to keep the structure stable for at least five to eight days. If packing is placed inside the nose during surgery, it is removed the morning following the surgery. Your face will feel puffy, especially the first day after surgery. Pain medication may be required. You are advised to avoid blowing your nose for seven days after surgery. In the immediate days following surgery, you may experience bruising and minor swelling in the eye area. Cold compresses often reduce the bruising and discomfort. Absorbable sutures are usually used that do not have to be removed. Nasal dressing and splints are usually removed six or seven days after surgery.

It is crucial to keep your head elevated after surgery. Some activities will be prohibited in the weeks after the procedure. Sun exposure, exertion, and risk of injury must be avoided. If you wear glasses, special arrangements must be made to ensure that the glasses do not rest on the bridge of the nose. Tape and other devices are sometimes used to permit wearing glasses without stressing the area where surgery was performed.

Follow-up care is vital for this procedure to monitor healing. Obviously, anything unusual should be reported immediately. It is essential that you keep your follow-up appointments. Insurance does not generally cover surgery that is purely for cosmetic reasons.

Dr Tollefson actively treats children and adults with orbital, mandible, midface, nasal and other facial fractures. Craniomaxillofacial reconstructive surgery deals with injuries to the face, neck, and skull that may be caused by sporting injuries, car accidents, or while at work. We want our patients to return to their daily lives with the least disability as soon as possible. Treatment may be coordinated with other specialists to obtain the best results, which may include dentists, orthodontists, 3D printing engineers, neurosurgeons, and ophthalmologists.
Dr Tollefson is on the Board of Directors for the AO CMF North American Education Board, which is dedicated to improving patient outcomes after facial fractures. He teaches courses around the US and internationally. Before treatment some patients with jaw fractures complain of difficulty eating, difficulty opening the mouth (trismus), and the teeth not aligning correctly (malocclusion). The goals of treating a patient like this will be to wire the jaws into the correct occlusion (relationship between the upper and lower teeth), to use titanium screws and plates to fixate the fractures internally, all while using the most minimal access through incisions.

Athletes may be struck in the eye socket or nose while playing sports. The patient problems that Dr Tollefson is then treating may include double vision (diplopia) or nasal obstruction and a crooked nose. Orbital fracture repair and repair of a traumatic nasal deformity are two special areas of Dr Tollefson’s interest. 3D CT scans and model printing as well as intraoperative CT scans are used to assure that the bones of the face have been well-aligned.
Lastly, skin scarring from these traumatic causes can be treated with laser resurfacing, dermabrasion or the full line of scar revision techniques and microfollicular hair transplantation.

Treatment of Facial Paralysis (reanimation)

Dr Tollefson specializes in the repair of facial nerve injuries with the full spectrum of nerve repairs, cable nerve grafts, static facial slings, and facial reanimation techniques. Dr Tollefson employs the most up-to-date facial reanimation techniques such as the masseteric nerve transfer, sural nerve cross-face grafting, temporalis tendon transfer (orthodromic) and free tissue transfer.

Probably no other physical characteristic cries out for facial plastic surgery more than protruding ears. Children, long the victims of cruel nicknames like “Dumbo” or “Mickey Mouse,” are the most likely candidates for otoplasty, but this surgery can be performed at any age after the ears have reached full size, usually around five to six years of age. Even if the ears are only mildly distorted, the condition can lead to self-consciousness and poor adaptation to school. When it comes to otoplasty, conventional wisdom is the earlier the better. Adults may also benefit from this procedure, which improves self-esteem with relative ease. Often, adults choose this surgery in conjunction with other facial plastic surgical procedures. Not only is it possible to “pin back” ears, but ears can also be reshaped, reduced in size, or made more symmetrical. If you are wondering how otoplasty can improve the way you look, you need to know how otoplasty is performed and what you can expect from this procedure. This pamphlet can address many of your concerns. Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific needs.
General good health and realistic expectations are prerequisites. It is also important to understand the surgery. Otoplasty will not alter hearing ability. What is important for successful otoplasty is that the ears be in proportion to the size and shape of the face and head. When considering otoplasty, parents must be confident that they have their child’s best interests at heart. A positive attitude toward the surgery is an important factor in all facial plastic surgery, but it is especially critical when the patient is a child or adolescent. Adult candidates for otoplasty should understand that the firmer cartilage of fully developed ears does not provide the same molding capacity as in children. A consultation with a facial plastic surgeon can help parents decide what is best for their child, not only aesthetically, but also psychologically and physically. Timing is always an important consideration. Having the procedure at a young age is highly desirable in two respects: the cartilage is extremely pliable, thereby permitting greater ease of shaping; and secondly, the child will experience psychological benefits from the cosmetic improvement.
Your choice of a qualified facial plastic surgeon is of paramount importance. During the consultation, the surgeon will examine the structure of the ears and discuss possibilities for correcting the problems. Even if only one ear needs “pinning back,” surgery will probably be recommended on both ears to achieve the most natural, symmetrical appearance. After the surgeon and patient decide that otoplasty is indicated, your surgeon will discuss the procedure. Following a thorough medical history, your surgeon will explain the kind of anesthesia required, surgical facility, and costs. Typically, your surgeon will suggest a general anesthesia for young patients and a local anesthetic combined with a mild sedative for older children and adults. Under normal conditions, otoplasty requires approximately two hours.
Soft dressings applied to the ears will remain for a few days. Most patients experience some mild discomfort. If you are accustomed to sleeping on your side, your sleep patterns may be disrupted for a week or so because you cannot put any pressure on the ear areas. Headbands are sometimes recommended to hold the ears in the desired position for two weeks after the surgery. The risks are minimal. There will be a thin white scar behind the ear after healing. Because this scar is in a natural crease behind the ear, the problem of visibility is inconsequential. Anything unusual should be reported to the surgeon immediately. Facial plastic surgery makes it possible to correct many facial flaws that can often undermine one’s self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself. Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve birth defects or traumatic injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.

Microtia repair Surgical correction of a congenital missing ear. An ear is created using a cartilaginous framework fashioned from rib cartilage (stage I), and subsequently refined by creation of an ear lobe (stage II), and creation of a crease behind the new ear (stage III).

Drooping of the skin around the eyebrows can create a tired, sad appearance. A browlift can correct this condition and lessen the appearance of excess skin of the upper eyelids. New video-assisted technology that allows this procedure to be performed with a few small incisions. The endoscopic browlift technique is less invasive and creates less swelling and bruising, with minimal complications. Endoscopic browlift is often performed in conjunction with eyelid surgery to rejuvenate the entire orbital and eyelid region.

The Surgery

The main difference among the various options for forehead lifting consists of the placement of the incision.
The newest approach we incorporate is endoscopic surgery. Several small one-half-inch to one-inch incisions are placed just behind the hairline. Although this technique may require more surgery time, it is less invasive and results in a smaller chance of temporary scalp numbness.
The procedure takes between one and two hours to perform. It is most likely performed under IV sedation or twilight anesthesia.

Post Surgery

You will experience a certain amount of swelling and bruising in the 10-day period following surgery. In some patients, this condition may include the cheek and eye area as well as the forehead. You will be advised to keep your head elevated in order to reduce swelling. Cold compresses may further reduce swelling. As the incisions heal, you may experience some numbness as well as itching, both of which will diminish with time. The sutures are usually removed within 7 to 10 days following surgery. If bandages have been used, they are removed in one to three days. It is important to follow instructions of when to resume normal activities. For most patients, the recovery time will not exceed two weeks, but patients may still be advised to avoid strenuous activities for longer periods. Any prolonged bruising can be camouflaged with standard make-up techniques.

Insurance does not generally cover surgery that is purely for cosmetic reasons.

The Surgery

An incision is made either in the natural crease line just under the chin or inside the mouth, where the gum and lower lip meet. By gently stretching this tissue, a space is created where an implanted can be inserted. This implant made of synthetic material that feels much like natural tissue normally found in the chin, is available in a wide variety of sizes and shapes. This allows custom fitting of the implant to the configurations of the patient’s face. After implantation, fine sutures are used to close the incision. When the incision is inside the mouth, no scarring is visible. If the incision is under the chin, the scar is usually imperceptible.
In chin reduction surgery, incisions are made either in the mouth or under the chin. The bone is sculpt to a more pleasing size. For orthognathic surgery, an incision is made inside the mouth and the facial bones are repositioned. The procedure, depending on the extent of the work, takes from less than an hour to approximately three hours.

Post Surgery

Immediately after surgery, the surgeon usually applies a dressing that will remain in place for two to three days. You will experience some tenderness. Post-operative discomfort can be controlled with prescribed medications. Chewing will probably be limited immediately after chin surgery, a liquid and soft food diet may be required for a few days after surgery. Most patients feel a stretched, tight sensation after the surgery, but this usually subsides in a week.

Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve genetic deformity or traumatic injury may be reimbursable in whole or in part.

Eyelid surgery is one of the most effective ways to improve facial appearance. As we age, the eyelid skin stretches, muscles weaken and fat protrudes. Through tiny incisions along the natural crease of the upper lid, inside the lower eyelids, or just below the lash line, the doctor removes excess skin and fat that cause bags and puffiness. The result is a refreshed appearance with a younger, firmer looking eyelid. In some patients, a browlift is recommended with eyelid surgery to correct a drooping brow and smooth the forehead. Due to the nature of the skin in these areas, recovery time is minimal and scars are almost nonexistent.

The Surgery

In upper eyelid surgery, individual lines and creases of the lids are marked in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar.
In lower eyelid surgery, an incision in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Eyelid puffiness caused primarily by excess fatty material is removed. When sutures are used to close this kind of incision, they are visible to the eye. They are also self dissolving and leave no visible scar. Under normal conditions, blepharoplasty can take from one to two hours.

Post Surgery

Immediately after the surgery has been completed, tiny sterile bandages may be applied. This is not done for transconjunctival blepharoplasty. It is not crucial that the eyes be covered. However, an ointment to prevent dryness of the eye area may be used. A certain degree of swelling and bruising is normal. Cold compress, as well as head elevation when lying down, will enhance healing and relieve discomfort. Medication can be prescribed for discomfort.
For a week and a half following blepharoplasty, you will clean the eye area (the eyes may feel sticky, dry, and itchy). Eyedrops may be recommended. You will be provided with a list of activities and environments to avoid in the weeks immediately following surgery. Permanent stitches will be removed in three to five days after surgery. Self-absorbing stitches will dissolve on their own.

Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve vision or surgery for eye deformity or injury may be reimbursable in whole or in part.

The facelift procedure can dramatically improve sagging skin of the cheek, jowls, and neck. It especially tightens the neckline and decreases the deep folds around the mouth. Dr. Tollefson is one of a few surgeons in the area performing the deep-plane facelift; a technique designed to provide significant tightening of the facial skin, while maintaining a natural appearance. The facelift procedure can be performed alone, or in conjunction with other aesthetic procedures, such as eyelid surgery or nasal reshaping.

The Surgery

An incision in the area of the temple hair, just above the front the ear, and then continues around the lobe, circling the ear before returning to the point of origin in the scalp (actual placement of incisions will vary from patient to patient). The skin is raised outward, the underlying muscle and connecting tissue is repositioned and tightened. Some fat may be removed, as well as excess skin. For men, the incision is aligned to accommodate the natural beard lines. In all cases, the incision is placed where it will fall in a natural crease of the skin for camouflage. After trimming the excess skin, the incision is closed with fine sutures and/or metal clips, which permit surgery without shaving hair from the incision line. Depending on the extent of the surgery, the process can take from two to four hours. When the procedure is performed with a combination of mild sedatives, local anesthesia, and a mild intravenous anesthesia, the patient will experience little discomfort. Sometimes a general anesthesia is used for facelifts. Following the surgery, a dressing will be applied to protect the entire area where the incisions have been made.

Post Surgery

Even though most patients experience very little pain after surgery, medication will still be prescribed. Some degree of swelling and bruising is unavoidable, and you will be instructed on the use of cold compresses to keep the swelling to a minimum. Any dressing will be removed within one to three days. You will be instructed to keep your head elevated when lying down, to avoid as much activity as possible, and to report any undue discomfort. Though there are few risks in facelift surgery and thousands are preformed every year, some risk exists in any surgery.
All sutures and staples are usually removed 5 to 10 days following surgery.
Recovery usually takes two to three weeks, though many patients go back to work in two weeks. Scars are usually not noticeable after enough time has passed for them to mature. In any case, they are easily disguised in natural skin creases, by the hair, or in persistent cases, by makeup until total healing has occurred. Bear in mind that the aging process continues after surgery and that some relaxation of tissues will occur over the first few weeks.

Insurance does not generally cover surgery that is done purely for cosmetic reasons.

Many new therapies and technologies are presently available to enhance the appearance of thin and wrinkled lips. These include fat transfer, injection of various filler materials (such as collagen, Restylane, Artecol, etc.) and placement of surgical implants. These procedures can restore a youthful appearance to the lips, minimize vertical wrinkles, or create a voluptuous and sensuous look.

BOTOX Cosmetic is a quick and minimally invasive procedure. You doctor makes a few tiny injections into the muscles that cause moderate to severe frown lines between your brows.
Your doctor will determine exactly where to administer the injections to achieve the best results. No anesthesia is required, although a cold pack or anesthetic cream may be used to numb the area prior to injection.
The entire procedure takes approximately 10 minutes, and there is no downtime afterward. Discomfort is minimal and brief. Localized pain, infection, inflammation, tenderness, swelling, redness, and/or bleeding/bruising may be associated with the injection.

You can expect to see results within days after your treatment. The appearance of the area between your brows may continue to improve for up to a week.
BOTOX injections help minimize or eliminate deep wrinkles caused by muscle contraction. This method is used primarily for wrinkle lines of the forehead, between the eyebrows, and the crow’s feet next to the eyes. Botox injections are simple, effective and allow you to return to work immediately. Result last four-to-six months and can be repeated.

AAFPRS Patient Injectable Safety recommendations

When the skin is in the process of recovering from an injury, whether the result of an accident, surgery, a burn, or acne, scarring will occur wherever multiple layers of the skin have been affected. Once a scar forms, it is permanent but may be made less visible or relocated surgically. With very few exceptions most people are self-conscious about facial scars. Some people may also experience diminished functioning of the eyes, mouth, or nose due to scarring. If you’ve wondered how facial scar revision could improve your appearance, your self-confidence, or your level of facial functioning, you need to know how scar revision works and what you can expect from this procedure. This pamphlet can address many of your and provide you the information to begin considering facial scar revision surgery. Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery is performed. Your surgeon can answer specific questions about your specific needs.
The most basic requirement for all surgery is good health. Other requirements are more subtle and should be carefully considered in discussion with your surgeon. Expectations of the surgery and of the surgeon must be realistic. A person considering facial scar revision must understand that there is no way to remove scars completely. The goal is to improve the appearance of the scar either by disguising it, relocating it, or minimizing its prominence. Skin color and type, age, and the type of scarring, are all important factors that must be part of the discussion prior to surgery. Different types of scars respond to different plastic surgery techniques. Timing of surgery is another important choice. Some surgeons advise against any scar revision in cases of injury for a period that might extend up to a year after the injury. This interval allows the body enough time to heal fully.
Whether the surgery is desired for functional or cosmetic reasons, your choice of a facial plastic surgeon is of paramount importance. Your surgeon will examine the scar in order to decide upon the proper treatment and inform you of outcomes that can be expected from facial scar revision surgery. Different scars require different treatments. For example, severe burns that destroy large sections of skin cause the skin to heal in a puckered way. As the skin heals, muscles and tendons may be affected in this “contracting” movement. Keloid scars are a result of the skin’s overproduction of collagen after a wound has healed. These scars generally appear as growths in the scar site. Hypertrophic scars, unlike keloids, do not grow out of the boundaries of the scar area, but because of their thick, raised texture, can be unsightly and may also restrict the natural movement of muscles and tendons. Some facial scars are unattractive simply because of where they appear on the face, while others affect facial expressions. All surgical possibilities will be discussed in the initial consultation along with risks involved for each type of scarring. The agreement between you and your surgeon on how to proceed is a prerequisite for successful surgery. After you both decide to proceed with scar revision, your surgeon will inform you about the anesthesia, the surgical facility, any supportive surgery options, and costs. Because scars are highly individualistic and the patient’s attitude toward scars is so personal, maximum improvement in facial scars may require more than one procedure, and more than one technique may be employed.
When a scar is of the contracture type, surgery generally involves removing the scar tissue entirely. Skin flaps, composed of adjacent healthy, unscarred skin, are then lifted and moved to form a new incision line. Where a flap is not possible, a skin graft may be used. A graft involves taking a section of skin tissue from one area and attaching it to another, and time must be allowed following surgery for new blood vessels and soft tissue to form. Z-plasty is a method to move a scar from one area to another, usually into a natural fold or crease in the skin to minimize its visibility. While Z-plasty does not remove all signs of a scar, it does make it less noticeable. Dermabrasion and laser resurfacing are methods a surgeon uses to make “rough or elevated” scars less prominent, by removing part of the upper layers of skin with an abrading tool or laser light. Clearly, the scar will remain, but it will be smoother and less visible. Keloid or hypertropic scars are often treated first with injections of steroids to reduce size. If this is not satisfactory, the scars can be removed surgically, and the incisions closed with fine stitches, often resulting in less prominent scars.
You can expect to feel some discomfort after facial scar revision surgery. Some swelling, bruising and redness are generally unavoidable. It is important for you to follow your surgeon’s after care recommendations to the letter. Though the sutures will be removed within days after the surgery, your skin needs time to heal. Surgeons generally insist on decreased activity after surgery and instruct the patient to keep the head elevated when lying down, to use cold compresses to reduce swelling, and to avoid any activity that places undue stress on the area of the incision. Depending on the surgery performed and the site of the scar, the facial plastic surgeon will explain the types of activities to avoid. No medication should be taken without first consulting the surgeon. It is important to remember that scar tissues require a year or more to fully heal and achieve maximum improved appearance. Facial plastic surgery makes it possible to correct facial flaws that can undermine self-confidence. Changing how your scar looks can help change how you feel about yourself. Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve scars caused by injury may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.