Facial plastic and reconstructive surgeon Jason Nellis describes his approach to addressing facial paralysis and improving facial asymmetry in a patient who had meningioma resection. A combination of aesthetic and reconstructive techniques offered the best approach to help meet the patient’s goals.
This patient presented after she had had neuro surgery. So she had an interesting history of bilateral meningioma that went around her carotid. And so she actually ended up needing extensive craniotomy to get to the tumor. So she recovered well after that surgery. So from a neurologic perspective was a great success. She had gone through neurosurgery and she'd recover really nicely. But when she came in, she said, you know, something else was missing and I think that was just addressing the facial deformity. So our treatment plan was using a combination of aesthetic and reconstructive techniques to try to improve her facial symmetry. So we used chemo denervation for her frontalis to get her brows in a more symmetric position as well as using dermal facia grafting to improve her temporal Halloween. So when working with patients to develop these reconstructive plans, one, a lot of times it takes multiple interventions and it's a mix of like non invasive invasive procedures to get to the patient's goal. In addition, from a timing standpoint, a lot of times patients present not right away but a year or even years down the line and really, it's never too late if they have facial deformity or a symmetry they want to address. So a lot of times, you know, we sort of see where they're at and then we talk about where we want to end up and that's, we work together to get there and it does take time one to plan out the sequence of steps, but also the recovery and things like scarring and swelling and it takes time. But down the road, we know where we want to end up. And patients find that over time that they develop a new normal and can go back to their normal routine already. She's reporting that she feels a lot better and she sort of feels more like she did even before her initial surgery. So I think she's going to do well.
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