Facial Plastic and Reconstructive Surgery

Elaine Hinkle, RN, and William Shockley, MD, Chief of the Division of Facial Plastic and Reconstructive Surgery

Facial Plastic and Reconstructive Surgery plays an important role in the clinical care of patients and in the education of residents. Dr. Shockley, Chief of the Division of Facial Plastic and Reconstructive Surgery says “Traditionally we have focused on patients requiring reconstructive procedures. More recently we have seen a number of patients seeking cosmetic procedures. In the US and abroad there has been tremendous growth in these procedures, especially office procedures performed without incisions, scars or side effects. As a result the popularity of Botox and soft tissue fillers has soared”. Dr. Shockley at UNC and Dr. Raymond Cook at Wake Med see a broad range of patients in consultation. Many of the reconstructive procedures are focused on the treatment and reconstruction of skin cancer, facial paralysis, facial and nasal deformities, and the medical and surgical management of scars.

Dr. Shockley was one of the invited faculty members at the Portland Rhinoplasty Course in July of 2008. This reflects his interest in rhinoplasty and seeing patients who might be candidates for rhinoplasty, as well as patients with functional complaints such as nasal obstruction and nasal valve problems.

With the nationwide emphasis on health and appearance there has been a shift from the more traditional cosmetic surgical procedures to office procedures which have minimal to no side effects and no associated down time. This allows the patients to come in for a “quick fix” and be on their way. Improving access has been a major goal of the Facial Plastic Surgery Service. Dr. Shockley is now seeing patients at Carolina Pointe and Dr. Cook sees patients at Wake Med North. This has provided a more optimal environment in which to see these patients.

Many patients are referred for surgical reconstruction. At UNC, Dr. Shockley sees a wide variety of patients with defects and deformities. “I still love reconstructive surgery. Each patient presents a particular challenge and hopefully we can come up with a unique solution. Of course our goal is to restore the patient’s function and appearance to as close to normal as possible.” Dr. Shockley’s special interests include rhinoplasty, reconstruction of facial cutaneous defects, skin cancer, surgery for facial paralysis, and scar revision.

Elaine Hinkle, RN has been Dr. Shockley’s nurse for 13 years. “Elaine has played a major role in the success of the Facial Plastic Surgery Clinic. She continues to play a critical role in our entire clinical enterprise. She is adored by the patients and is one of the most respected and dedicated nurses at UNC Hospitals” says Shockley.

Dr. Raymond Cook a fellowship trained Facial Plastic Surgeon at Wake Medical Center also sees a variety of patients. His interests include both surgical and non-surgical forms of facial rejuvenation and reconstructive surgery secondary to trauma and cancer. Dr. Cook’s goal is to enhance or restore the intrinsic beauty, which is present in each individual, rather than create a result that appears “surgical.”

Dr. Cook sees his cosmetic patients in the WakeMed North office in North Raleigh. The office has recently acquired the Portrait Plasma for skin regeneration. The Portrait Plasma is the next generation of medical laser technology. Dr. Cook has had great success using the Portrait Plasma to treat multiple patients for wrinkles, fine lines, texture and imperfections in skin tone and discoloration.

From an educational standpoint there has been an expansion in the facial plastic surgery curriculum. Facial Plastic Surgery Conference meets twice a month and has been a big hit with the residents. In addition to reviewing chapters from a facial plastic surgery text, there are lectures from the UNC faculty, guest lecturers and journal clubs. Residents see patients in The UNC Facial Plastic Surgery Clinics with a broad range of disorders including: facial skin lesions, skin cancer, congenital or acquired facial and nasal deformities, microtia, facial paralysis and vascular lesions. Recently there has been a surge in patients requiring functional rhinoplasty, nasal valve problems, and esthetic rhinoplasty. Consultations are also available for those seeking facial cosmetic procedures.

What's New in Facial Surgery?

The advances in bio-technology have led to the introduction of several new materials which have found uses in facial surgical procedures. Dermabond has recently been introduced as an alternative to skin sutures. This tissue glue can be applied to appropriate incisions and lacerations, thus avoiding stitches. It is particularly applicable for superficial facial wounds and in children, where taking out the sutures can also be troublesome. Gore-Tex is a synthetic material which has been found to be very compatible with host tissues and is useful for filling in soft tissue deficiencies. In addition, it can be used to provide structure and contour to the cheeks, chin and the bridge of the nose. In addition, Gore-Tex is now being used to restore facial symmetry in patients with long-standing facial paralysis. Alloderm, a type of artificial skin, has also found many new uses. It is particularly useful as a soft tissue “fillers” cover bony irregularities, or fill in deficits in the subcutaneous tissues of the face. It has recently been used to minimize the post-parotidectomy deformity that often occurs following this procedure. There also continue to be advances in the miniature plates and screws used to fix facial fractures. The newest idea is that of the absorbable plates which are designed to hold bones in position during the healing phase and then dissolve over the next several months after the fractures have fully healed.

As with all new technologies and techniques there are always advantages, disadvantages and potential risks. The surgeons at UNC are always happy to discuss these new advances and as well as the applications to patients who may benefit from this new technology.