Chapter 5 of 8 · Surgical Management
Surgical techniques
Common Facial Injuries and Surgical Techniques
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The majority of intimate partner violence victims are women.
In emergency rooms at hospitals, one of the standard screening questions for most patients is 'do you feel safe in your home?'
Double board certification in facial plastic surgery means completing standard otolaryngology training (head and neck anatomy, cancer resections, sinus surgeries, tonsillectomies) plus an additional year specializing in cosmetic and reconstructive facial procedures.
Rhinoplasty has both functional components (breathing) and cosmetic components, and these can be addressed together in reconstructive cases.
The nose is the one facial feature that should not be noticed; when it is noticed, it's because it doesn't match the rest of the face.
In rhinoplasty, the internal nasal structures must be optimized first because the inside influences the outside; if internal congestion and swelling are not addressed, external swelling takes longer to resolve.
Through the Face to Face program, surgeons see patients only after they have completed their journey with mental health experts and have fully extricated themselves from the abusive situation.
Emotional healing from domestic violence is never completely done; survivors still experience pain when recounting their stories even years later, though it may lessen with time.
The most common facial injury from domestic violence is a broken nose, as it is the easiest bone to fracture and is positioned prominently.
Other common facial injuries from domestic violence include jaw injuries, eye socket (orbital) fractures, dental injuries, and soft tissue injuries such as lacerations from objects.
Post-trauma rhinoplasty is more complex than elective rhinoplasty because traumatic fractures are uncontrolled and can result in completely different shattering patterns compared to controlled surgical fractures.
Bruising and swelling from facial trauma is much more widespread than in controlled surgical settings.
After facial trauma, healing may not occur properly, resulting in deviation, sunken areas, or loss of blood supply to cartilage.
Reconstructive nasal surgery after trauma may require cartilage grafts from the ear or rib when the nose's own cartilage has not survived.
The nose is the most unforgiving facial structure; every small injury can cause a visible defect.
The bone and cartilage structure of the nose supports the overlying skin; without proper structure, the skin collapses.
In open rhinoplasty, a small incision is made in the columella (the tissue between the nostrils) along with strategically hidden internal incisions, allowing the skin to be lifted to access and rebuild the underlying cartilage and bone.
Chronic pain and inflammation from bodily injuries, along with psychological trauma, are more difficult to address than physical disfigurement.
Survivors of domestic violence may still experience PTSD symptoms even after successful reconstructive surgery.
Surgeons stay current with the latest techniques by attending professional meetings twice per year, where colleagues share innovations intended to shorten recovery time and minimize incisions.
In the Face to Face program, surgeon services are provided pro bono, but facility fees, anesthesiologist costs (when not donated), and patient medications (antibiotics, sprays) may require funding.
The Face to Face program connects patients with mental health experts who provide long-term support for emotional recovery.
According to census data from multiple sources, approximately 1 in 2 women in the US encounter some form of violence from intimate partners, whether sexual, physical, or stalking.
Approximately 2 out of 5 men experience intimate partner violence.
Approximately 85% of domestic abuse victims are women.
About 70% of domestic violence injuries occur in the facial region.