So, some patience have this doubt even after 3 years of trauma or accident, Can you still improve the cosmesis of the face? Can you still improve the look of the patient? I am here to discuss this today, I am Dr. Priti Udhay, from DRR Face Aesthetics, Chennai.

So whenever you have an accident and you have fractures and if these fractures are not repaired on time or if they have been repaired incorrectly, the bones will fuse in the wrong places. So we have now the latest technology in which event at a late stage, like after 2 years, 3 years, 4 years, we are able to cut these bones again move them to the normal place and then reconstruct and improve the cosmesis.

I am going to tell you this through an example of one of my patient, so this is a patient from out of country, he’s from Bangladesh. He has severe road traffic accident, you can see that he has eye deformity, the right eye is sunken in, also there is a fracture in tear drainage part, therefore you can see the swelling from both the eyes, these are swellings of the lacrimal drainage pathway and he also has a lot of scars on the face, and he is a young boy and whether we can give a cosmetic improvement to him or not is the question now. So these are the patients who come to us late, we can definitely improve them but they need staged repair, you cannot do everything in one sitting with these patients. So for him, what we did first is body repair, whatever bones were fractured, we cut those bones which were united in the wrong place, we moved them in the right direction and reconstructed the bony framework first. We cannot do this when the fractures are very severe and in pieces, so in those cases we make a 3D printed skull model of the patient and we plant the surgery on the skull model, we know how much bones have to be moved compared to the other side in what direction we can move them and what is the kind of rotation we need, and we can also contour the implants on these models first.

During surgery we use navigation guidance, which is just like GPS, during surgery we know exactly where we are on the CT scan of the patient, so it is s live guidance during surgery, so we also know whether the implants are placed in the right position or not. We can verify that even during surgery, we don’t have to wait for the CT scan which is done usually after surgery, so once this bony reconstruction is for him, we also did the surgery for his tear drainage pathway, that is the DCR surgery in the first sitting. So you can see that is eye has moved forward now after this basis creator, but the soft tissue is not repaired, we cannot do both together when the patient presents late. So here the eyelid is down so we took some dermis and fat from the buttocks and we placed it in the lower eyelid which pushed the eyelid up, gave volume to the area, then he looked much better after the second surgery. So these kind of patients need higher technology, higher expertise but we can definitely give them a better cosmesis even after many years of injury. Thank You.