plastic

Use of Prostheses. Often the substitute for missing tissue is a prosthesis, a replacement not made from living tissue. It may be inserted beneath the skin (such as to build out a receding chin) or attached to the skin surface (for example, to replace an ear). Prostheses attached to, not inserted beneath, the skin frequently are employed to fill out depressed or missing facial areas, the aftereffects of accidents, cancer, or war injuries. In building such a replacement, the surgeon first makes an impression of the face and a plaster cast of the impression. The substitute part is molded in wax or clay in the plaster cast, and from this model the actual replacement part is made. Such parts, molded and painted to match the texture and color of the skin, have been used to replace many structures, including missing ears and noses.

Use of Cartilage, Skin, and Bone. Noses and ears also have been reconstructed with rib cartilage and skin grafts. Eyebrows have been made by the use of skin grafts from the scalp, and chest deformities repaired by the use of bone chips from other parts of the body.

Sometimes a nose is remodeled to correct a hump or hook, or a saddle nose (a depression on the ridge), or a twisted nose. Incisions are made inside to avoid causing outside scars, and the surgeon either removes excess cartilage or bone, or inserts it, according to the improvement wanted. Cartilage and bone may be obtained from other parts of the body, usually the ribs or hip. After the operation, the skin over the nose adapts to the new structure.

Dermabrasion. Skin blemishes such as acne scars and pits can be “sandpapered” or planed. This technique, called dermabrasion, seeks to correct superficial blemishes and to remove superficial accumulations of pigment. However, as dermabrasion can occasionally cause increased scarring or introduce variation in skin color and texture, such treatment is infrequently performed today.