What Is a Facial Mass?
A facial mass is any lump or bump on the face or neck. This includes tumors, growths, and cysts. Sometimes, these masses may be cancerous, but often, they’re simply benign masses of skin.
Who Can Develop Facial Masses?
Anyone can develop facial masses. Neck masses are more common in individuals who have enlarged lymph nodes from frequent infection, but anyone can get cysts, moles, or growths on the neck and face.
Patients with sun-damaged skin are more likely to develop cancerous growths, although cancer can affect anyone. While cancerous masses are rare, it’s usually a good idea to get suspicious facial masses examined by a healthcare professional.
How are Facial Masses Treated?
The most common way to treat a facial mass is to get a biopsy. A biopsy takes a tissue sample from the growth so a doctor can examine it for cancerous cells.
If the growth is benign, it can be easily removed through surgical excision. This is a simple procedure performed with a local anesthetic in the office.
While every excision means that there will be a scar, the scar can be designed to be well camouflaged in natural skin creases or lines and precise surgical technique can help create the best possible aesthetic outcome. After the growth is removed, the incision is closed with sutures. Your surgeon will determine whether dissolvable or non-dissolvable sutures are right for the particular area and size. If non-dissolvable sutures are used, these will be removed between 5-7 days. The scar will continue to fade over time and blend into the skin and rest of your face.
If a biopsy finds that a facial mass is cancerous, additional treatment may consist of further surgery and/or radiation therapy and chemotherapy depending on the type of cancer, the location and its size.
Functional Nasal Surgery
What is Functional Nasal Surgery?
Functional nasal surgery refers to any surgery that treats chronic conditions that affect the sinuses. Difficulty breathing through the nose, nasal congestion, and/or frequent sinus infections,can occur due to how the inside of the nose is shaped. Sometimes the obstruction may have been caused by an injury or nasal fracture. Changing the shape of the inside of the nose is a way to relieve these conditions
Who Should Undergo a Functional Nasal Surgery?
Anyone in good health who experiences difficulty breathing through the nose, frequent or chronic sinusitis and/or nasal congestion may benefit from functional nasal surgery. These chronic conditions can be caused by anatomical issues like a deviated septum, nasal valve collapse or narrowed nasal valves, a nasal bone fracture, a congenital defect such as a cleft lift and/or enlarged nasal turbinates.
During your visit, Dr. Burchhardt will examine both the outside and the inside of your nose to evaluate where the areas of anatomic obstruction are. Frequently, nasal endoscopy is used, which involves using a camera to be able to look farther inside your nose. CT imaging is needed to evaluate for any bony fractures or chronic sinus disease. Depending on the area of obstruction, you will be offered repair of the structures that are causing a blockage in you. . While the goal of functional nasal surgery is to improve nasal breathing, patients may choose to have a cosmetic rhinoplasty done at the same time to make any aesthetic changes. Dr. Burchhardt specializes in both reconstructive and cosmetic surgeries and can help counsel you on the treatment options that are best suited for each individual.
How Do Functional Nasal Surgeries Work?
There are several kinds of functional nasal surgery that all address different structures that might be the cause of a constricted nasal airway. Two of the most common are septoplasty and nasal turbinate reduction. If you have a deviated septum, you may be a candidate for septoplasty, which involves straightening out your septum. The septum divides the right side from the left inside your nose and consists of both cartilage and bone. During a septoplasty, the cartilage and bone inside your septum deeper inside your nose are removed, thus allowing the septum to sit in the midline. If you have large turbinates, these can be shrunk and pushed towards the sidewall to give you more breathing room. Both these procedures are minimally invasive and usually performed as outpatient procedures. In addition, incisions are made inside the nose, so there is no visible scarring. Sometimes, in cases of a severely twisted septum, the procedure is done through an “open approach” in which case a small incision is made in the narrowest part of your columella – the piece of skin between your nostrils. All other incisions are inside your nose.
Some people have poor support in the sidewall of their nose, leading to visible collapse of the nostrils and/or side wall when breathing in. This is usually worse with deeper breathing such as during exercise. This area of the nose is called the nasal valve, and it can be reinforced or made stronger with surgery to help you breathe better. This procedure is called repair vestibular stenosis or repair nasal valve collapse and involves using cartilage to help provide more support and stent the valve open. This procedure is frequently done together with a septoplasty.
In cases of prior injury that led to a nasal bone fracture, a reconstructive septorhinoplasty may be needed to help you breathe better, which involves restructuring your nasal bones and the septum to create more breathing room in your nose. This is different from a cosmetic rhinoplasty, which aims to change the nose for appearance-sake, such as removing a hump along the bridge or narrowing the tip of the nose. In both cases, cartilage is usually used as grafts to help change the shape and/or provide support.
Sometimes, endoscopic nasal surgery may be needed to help your surgeon visualize the inside of your nose better. A camera is inserted into the nose through the nostril to help your surgeon view the inner nasal passageways.
Mohs Reconstructive Surgery
What is Mohs Surgery?
Mohs surgery is a technique for treating skin cancer on the nose. The surgery involves removing multiple layers of skin to excise the cancerous tissue and performed by dermatologists who specialize in Mohs surgery. While effective at removing cancerous lesions and growths, one is left with a defect from where the growth was removed, which needs to be closed or reconstructed.
Why Do You Need Reconstruction after Mohs Surgery?
Mohs surgery is performed by removing layers of skin and testing the tissue in between the layers until there are no longer any cancerous cells seen in the tissue. When many layers need removal, it can leave what looks like a hole. If this area is small, it may be possible to close it simply by suturing. But if the area is large or goes very deep, further reconstruction might be needed to achieve a nice aesthetic and cosmetic result. .
Reconstruction after Mohs surgery can help these patients feel more confident about their appearance.
How Does Facial Reconstructive Surgery after Mohs Surgery Work?
Facial reconstructive surgery is usually performed as an outpatient procedure a few days after having Mohs surgery. Depending on the size of the defect or hole and the area of of the face or neck that is involved, the surgery itself can be performed using a skin graft or local flap.
A skin graft involves taking a piece of skin from a different part of the body – often from behind the ear, the shoulder bone or the outer thigh depending on the desired thickness of the graft. It is then sutured onto the defect.
A local flap involves sliding skin and tissue from the surrounding area onto the defect. Depending on how large the lesion was that was removed with Mohs surgery, a small or large flap may be needed. For reconstruction after Mohs surgery on the nose, cartilage may be required to support the nose and to help prevent breathing problems in the future. In more complex reconstructions, more than one surgery may be required. For areas where there was a lot of tissue loss and even after reconstruction there is a lack of volume, fat transfer may be done to help improve facial symmetry. In some cases, tissue expanders may be used. This involves placing an expander under the skin, usually the forehead, to grow more skin to cover the lesion from the procedure. As the skin needs time to grow, the surgery takes place over at least two sessions.
What is Scar Revision?
Scar revision is a kind of reconstructive surgery that reduces the appearance of scars. These scars may be due to injury or previous surgery. Minimizing the visibility of extensive scarring can help a patient feel more confident about their appearance.
Who is a Good Candidate for Scar Revision?
Scars in the face or neck can be unsightly and draw unwanted attention. This can be due to the length or the width of the scar or due to an unfavorable location. Some scars that are abnormally wide are called hypertrophic scars, while keloids are scars that are raised. In a keloid scar, the scar tissue has grown beyond the original boundary of the scar and can even look like a mass. Keloids are particularly common on and around the ear but can occur anywhere. Scar revision is for people with scars who are unhappy with their scars and want to improve the appearance. .
There may also be scarring that causes discoloration or scars that restrict movement due to tissue loss, like from a burn, severe trauma or from prior surgery. Whatever imperfections you may have, facial plastic and reconstructive surgeon Dr. Burchhardt at Chicago ENT can help you achieve your desired appearance.
How Does Scar Revision Work?
Scar revision surgery varies depending on the kind of scar you have. In some cases, you may not need surgery at all.
Scars take time to mature – usually up to 12 months. During the initial healing period, it is important to apply sunscreen regularly and ointment to moisturize the skin. Silicone sheeting is a commonly accepted scar treatment that has been shown to help reduce the appearance of scarring. Other scar-reducing ointments may also help. In some cases, you can apply a topical treatment, in the form of a prescription gel, over the scar.
A very common treatment of young scars that are starting to grow too large or are becoming raised or widen, is steroid injections. This non-invasive treatment involves injecting a small amount of liquid steroid solution into the scar. Within a few weeks, the scar tissue will start to break up. As a result, the scar can become softer and shrink. Depending on the size of the scar, several such treatments may be needed.
If there is volume loss or the scar is very depressed such as acne scars, dermal filler injections can help add volume. Significant volume loss may be treated with fat transfer, where fat is taken from the lower abdomen and injected into the scar to help restore symmetry. In select cases, tissue expansion may be needed to help stretch the nearby skin to then help cover the scarred area with surrounding healthy skin.
If a scar is discolored, other methods in reducing the appearance of the scar include dermabrasion, light therapy, chemical peels, and skin bleaching, which can lighten any discoloration caused by scarring.
For large scars, sometimes the best treatment method involves excising the scar and re-closing the area with the goal of a new but ultimately less visible scar. A meticulous layered incision closure can help minimize the appearance of a previous incision that healed poorly by creating a new incision and closing it through one layer of skin at a time. However, it may take a combination of scar revision techniques before your surgeon achieves the best results for minimizing your scarring.
Re-orienting a scar so that it is better camouflaged in naturally occurring skin lines or wrinkles may be an option. And sometimes re-closing the scar with local flaps that slide healthy skin over to cover the excised scar area, or using skin grafts where healthy skin is taken from a different part of the body may be the best option.
What is a Septoplasty?
A septoplasty is a procedure that corrects irregularities in the septum and straighens it out. The septum is the part of your nose in between your nostrils that extends deep into the nose and separates the right side from the left
When the septum is deviated, meaning it is crooked and not in the midline or if it is particularly thick, it can cause nasal obstruction and health issues. A deviated septum could be simply due to an asymmetry while growing up, but in some cases, it can stem from an accident or septal fracture. Patients with facial congenital defects such as a cleft lip and/or palate, frequently also have a deviated septum. Correcting this irregularity is often the most effective way to treat these problems.
Who Should Consider Having a Septoplasty?
You could consider having a septoplasty if you struggle to breathe through your nose due to having a deviated septum. A septoplasty does not treat nasal allergies, which are treated with nasal steroid sprays and over the counter allergy pills.
A deviated or enlarged septum can make it difficult to breathe and can even contribute to sleep apnea in some patients. Having a septoplasty is an efficient way to treat and even eliminate these persistent health problems and improve quality of life by being able to breathe through the nose instead of the mouth.
How Does It Work?
A septoplasty is usually performed as an outpatient procedure, where you go home after the surgery. It is usually done under general anesthesia with the patient fully asleep.
For a routine septoplasty, your surgeon makes a small incision inside the nose. Through this incision, the septal cartilage and bone deeper inside your nose can be trimmed, leaving you with a straighter septum. The incision is then closed with absorbable sutures that dissolve over time. Sometimes, small splints inside the nose are used to hold the septum in place during recovery. These won’t be visible from the outside. While a more common practice in prior decades, nasal packing is very rarely done these days.
If the septum is very deviated in the front of the nose and/or between the nostrils, an open approach may be chosen by our surgeon as a routine septoplasty will be insufficient in addressing the very front of the nose. In this approach, a tiny incision is made in the skin between your nostrils and connected to additional incisions inside your nose to get full access to the septum and to be able to perform more complex maneuvers to straighten out the septum. ChicagoENT’s facial plastic surgeon Dr. Burchhardt specializes in such complex nasal reconstructions. Cartilage grafting, sutures, cartilage scoring among other techniques may be needed to help re-position a very crooked septum. Frequently, an inferior turbinate reduction which decreases the size of the turbinates and pushes them towards the sidewall of the nose is combined with septoplasty to help maximize space for breathing in the nasal passage.
Recovery for many patients is often quite fast, though you won’t be able to breathe through your nose for a few days during the healing period, and while splints are in place. Most patients return to their normal activities within a week or so. It is best to stay away from strenuous exercise for two weeks after the surgery.
Valve Collapse/Vestibular Stenosis
What is a Nasal Valve Collapse / Vestibular Stenosis?
The nasal valve is the narrowest art of our breathing passage inside the nose. We have an external valve which is where our nostrils are and the internal valve that sits just a bit farther inside the nose. Nasal valve collapse can happen when the nasal valve is not well supported and collapses inward with breathing through the nose. Usually, this is due to weak, misshapen and/or suboptimally oriented cartilage inside our nasal sidewall that as a result are unable to withstand the negative inspiratory pressure from breathing in air. As a result, the sidewall collapses leading to a narrowed nasal passage and causing nasal obstruction. This obstruction is usually worse with deeper breathing such as during exercise.
A related issue is a vestibular stenosis, which occurs when the nasal valve is narrowed at all times, instead of collapsing in only with breathing. The nasal valve could be narrowed due to scarring from either trauma or prior surgery or from a inherently narrow nasal shape.
Who is at Risk for Nasal Valve Collapse?
Anyone who has difficulty breathing through the nose should undergo a thorough physical exam to determine the source of the obstruction. Common areas of obstruction are a deviated septum and/or enlarged inferior turbinates, but the nasal valve needs to be assessed as well for presence of collapse or inherent narrowing. Prior surgery such as rhinoplasty or skin cancer reconstruction place a patient at higher risk for nasal valve collapse, though most commonly the unique positioning, shape and inherent properties of of someone’s nasal cartilage is the root cause of nasal valve collapse. And sometimes, nasal valve collapse can happen simply due to thinning and loss of support of the nasal tissue caused by aging.
How is Nasal Valve Collapse Treated?
Non-surgical remedies for nasal valve collapse or vestibular stenosis can be breathe right strips or nasal cones. Both of these help stent up the sidewall and widen the airway. Some patients use these at night or during exercise, but these are clearly not great solutions for everyday life. As a result, nasal valve collapse or vestibular stenosis is best treated through surgery. This may involve cartilage grafts, temporary or permanent sutures to hold the valve in place, tightening the skin inside the nose, or broadening the nasal bridge among others.
Frequently, nasal valve surgery is combined with a septoplasty during which septal cartilage is removed that can be used to help support the weak sidewall cartilage. For valves that are too narrow, sliding in grafts along the dorsum can help stent the space slightly more open. Some can be minimally invasive, and all these techniques are designed to support the collapsed airway and to create more space so the patient can breathe again.
Deciding which nasal valve or nasal vestibular stenosis repair works best for you is mainly up to your doctor. ChicagoENT’s facial plastic and reconstructive surgeon Dr. Daniela Burchhardt specializes in complex nasal airway reconstructions and help recommend the best treatment suited for you, your age, the area of collapse and the root cause of it. Some patients may elect to undergo a cosmetic rhinoplasty at the same time if there are any cosmetic changes they’d like to address.
Septal Perforation Repair
What Is a Septal Perforation?
A septal perforation is essentially a hole or defect in your septum. The septum is the divider inside our nose, separating the right side from the left. It consists of cartilage and bone sandwiched in between mucosa, which is the lining in our nose. When there is a hole in this dividing wall, this is called a perforation. The most common causes of a septal perforation are prior septoplasty where the mucosa did not heal together after the inside cartilage or bone was removed as part of the surgery. Intranasal drug use such as cocaine or even over-the-counter decongestant sprays can lead to a septal perforation by restricting blood flow that ultimately leads to the death of the tissue. In some cases, repetitive picking at crusts and the resulting repeated damage and trauma can lead to the mucosa dying and a resultant hole. And in some cases, a medical disorder such as granulomatous or autoimmune disorders can cause septal perforations over time with uncontrolled disease.
In severe cases with a very large septal perforation, a nose can lose its support and start to buckle in, leading to a saddle nose deformity. A saddle nose deformity requires a reconstructive surgery with cartilage and possibly bone grafting to rebuild the nose.
Who is a candidate for Septal Perforation Repair?
Not all septal perforations are bothersome to a patient. Some patients might not even know that they have one! Septal perforation repair makes sense when the perforation is bothersome to the patient through whistling, crusting, or bleeding. If the perforation is located far towards the front or the top of the nose, it could lead to loss of support over time and risk developing a saddle nose deformity. This is another great reason to undergo septal perforation repair.
What Does Septal Perforation Repair Entail?
A non-surgical repair involves placing a septal button, which is essentially a small implant fitted into the perforation to block the hole. These stay in place and are periodically replaced. Surgical repairs are the definitive repair that close the hole with tissue. This tissue can be borrowed locally from inside the nose or taken as a graft from outside the nose. Facial plastic and reconstructive surgeon Dr. Burchhardt will help you properly assess the extent of your septal perforation and will counsel you on the treatment options available to you.