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- Presentation
Strategies for Managing Facial Multi-Unit Defects and Cosmetic Subunit Borders
Description
The speaker discusses how facial reconstruction should be guided by cosmetic subunits and their borders, emphasizing that even when a defect seems simple, the repair can affect nearby aesthetic units and produce visible distortion. He explains that subunits are the distinct areas that give the face its natural contours, and that surgeons must decide whether to ignore, change, move, respect, recreate, cross, go around, or go under these borders depending on the defect and the available tissue reservoir. Using examples from the ear, eyelid, eyebrow, cheek, lip, nose, and forehead, he shows how different techniques such as linear closure, wedge repair, advancement flaps, gull wing flaps, interpolation flaps, tunnel flaps, grafts, and V-to-Y repairs can restore form, but each carries trade-offs in symmetry, contour, bulk, and function. He stresses that while not every defect is a true multi-unit defect, every facial defect requires multi-unit thinking, careful anatomical knowledge, and an appreciation of how repairs interact with natural borders to achieve the best cosmetic outcome.
View moreConclusions
- The presentation concludes that facial reconstruction should be guided by subunit anatomy, because the borders between cosmetic units strongly influence both function and appearance.
- It argues that not every defect is truly multi-subunit, but every facial defect should be evaluated with multi-subunit thinking in mind.
- The speaker concludes that ignoring borders is usually a poor strategy, since even seemingly simple closures can distort nearby contours and create visible asymmetry.
- Some subunits are more critical to recreate precisely than others, with the eyelid and other highly functional areas demanding more exact reconstruction than less essential areas such as portions of the ear.
- The presentation suggests that borders can be managed in multiple ways—changed, moved, respected, recreated, crossed, or bypassed—depending on the defect and the aesthetic goals.
- It emphasizes that crossing or going through a border can be acceptable when it produces a better overall outcome than rigidly preserving the original line.
- The talk concludes that successful reconstruction depends on knowing where tissue reservoir exists and how local tissue can be advanced, tunneled, or transferred.
- It highlights that matching or recreating natural contour often matters more than perfectly preserving an original line, especially when the body can partially remodel over time.
- The presentation ends by stressing that surgeons should respect anatomy and subunit boundaries, but not be afraid to use creative reconstruction when needed.
- Overall, the research message is that thoughtful, anatomy-based flexibility produces better reconstructive outcomes than strict adherence to borders alone.
- J Am Acad Dermatol, Volume 65, Number 1.