External tumors of the face can create long-lasting disfigurement and serve as a painful reminder of one’s health crisis during a time of sickness. It is important to fully remove facial growths and reconstruct affected areas of the face to promote psychological healing and restores a person’s looks to their familiar appearance. Dr. Robert Mounsey of Revesse of Toronto specializes in facial plastic surgery. He has extensive experience in performing facial reconstructive surgery, including facial tumor excision and flap reconstruction.
What is a Tumor?
Tumors may be benign (harmless) or malignant (harmful), and they should be diagnosed and treated by a doctor. A tumor is a growth that forms when old cells that would normally be eliminated by regular cell turnover instead form a collection of cells resulting in a tissue mass. In malignant tumors, the cells are cancerous and do not divide in an orderly way but rather in an uncontrolled fashion. The cells of a malignant tumor can affect other areas of the body. Sometimes these areas are distant from the original site of the lesion in a medical process termed metastasis, or the spread of cancer from its site of origin. Because patient health is of the utmost importance, the doctor must ensure that each patient is in good health prior to a cosmetic skin flap reconstruction procedure.
Common Benign Facial Growths
Human skin is susceptible to a number of growths and often for unknown reasons. Vascular lesions like cherry angiomas and pyogenic granuloma can be raised and red in color, but they are completely harmless. Depending on the size of the growth and other signs it may exhibit, these small, benign lesions may be removed. Fatty tissue can form lipomas, which do not often occur on the face but can grow on the neck. These large, bulbous growths can become very heavy and noticeable through the skin. Issues with the sebaceous glands of aging skin can cause sebaceous hyperplasia, with growths noted to form up to 5 centimeters in diameter, though most are just a few millimeters. Growths masquerading as moles may actually be seborrheic keratosis, nevi, or even keratoacanthoma. While mole-like lesions can be the result of age, acrochordon (or skin tags) are common in obese patients and growths like warts are the result of a virus. There are a number of other skin conditions that may present like benign tumors, and these can be addressed by a dermatologist, plastic surgeon and, in some cases, an oncologist to ensure optimal health of both the skin and body.
Many benign growths are small enough that they can be removed and the site sutured closed with little or no reconstructive methods. The doctor’s work will still result in more delicate facial scarring or no discernable marks at all. Medical doctors and surgeons are most concerned with patient health and often do not have the aesthetic training or understanding of patient psychology to preserve the patient’s looks. In such cases, the doctor may revise another surgeon’s work for optimal patient healing.
Malignant Facial Tumors
Most patients are familiar with skin cancer as the main cause of malignant facial tumors. More often than not, because these lesions are highly visible, patients or doctors tend to notice them relatively quickly after formation, which can lead to their prompt removal. Actinic keratosis is a dry patch of skin that is actually the beginning of a cancerous formation, while basal cell carcinoma, squamous cell carcinoma, and melanoma form cancerous skin growths. Basal cell carcinoma is the form of skin cancer people most commonly experience, while squamous cell carcinoma is the second most common type. Melanoma is the most serious form of skin cancer and must be diagnosed early for the best prognosis.
There are other cancerous facial tumors that can form on the face, such as those in the parotid or salivary gland. The majority of the time these growths are benign, but they can be malignant in 20% of cases. Tumors can also grow within the lymph nodes of the neck and may be a sign of an initial cancer diagnosis or metastasis from another region of the body. Other tissues of the face may produce tumors due to cancerous growths.
Excision and Flap Reconstruction Surgery Explained
As explained, there are several different types of tumors that may occur on the face, many of which can cause disfigurement or distortion of a person’s looks. These masses can also affect the health of other facial tissues, requiring removal. Reconstructive procedures can vary depending on a number of factors, including the type of tumor and its respective size.
During an excision procedure, the tumor is cut from the location of its growth. In the event of a cancerous tumor, the surgeon may be required to remove extra tissue to ensure the neighboring skin and tissues are healthy and cancer-free. In some procedures, a microscope may be used to ensure the remaining layers of skin show normal cell formation. Certain cases require further reconstructive procedures. Excision is the first step in any flap reconstruction or other type of cosmetic wound closure surgery. The incision is then sutured closed with great care in an effort to avoid visible scarring, and the doctor may elect to employ the flap reconstruction procedure.
Flap reconstruction is a surgical technique used to graph the patient’s own skin from another area of the body to the site of the excised facial tumor. The skin flap is comprised of skin and its underlying tissues, like blood vessels, fat, and in certain cases muscle. When the skin flap is harvested from a nearby site, the tissues’ blood supply can remain connected to the donor site during the transport of skin. When the flap is taken further from the affected area, the tissues will be completely excised and reattached to the blood vessels where implanted. A flap reconstruction surgery calls for additional incisions in the skin and the manipulation of the tissue to cover the surgery site. Skin that has been separated from surrounding areas may be rejoined with other flaps of skin.
While small lesions can be removed in the office setting, more extensive tumor removal procedures performed by Dr. Mounsey will take place in an affiliate hospital or private clinic in the Toronto area. Local anesthesia or general anesthesia may be used, depending on patient needs. Some patients are comfortable being conscious for the surgery, while others may prefer to be fully asleep. Sedation can be combined with local anesthesia in patients who may not be healthy enough or comfortable with general anesthesia, where the body is in a controlled state of unconsciousness.
How Tumors Damage Areas of the Face
Growths can aggressively impact various tissues of the face, especially if they are malignant. These types of tumors can also spread the disease throughout the face and the rest of the body. Cancerous tumors require more aggressive removal to ensure that any tissues the cancer has impacted are also removed to reduce the likelihood of the cancer spreading or remaining on the face.
In benign tumors, the growth does not invade structures of the face or body but may stretch overlying skin and impede the function of other tissues like blood vessels and nerves. A lack of blood supply to tissues can cause necrosis, or tissue death, and compression on nerves may cause pain or permanent damage. These growths can affect the health of tissues of the face.
Types of Facial Skin Flaps
The two types of facial skin flaps are axial flaps and random flaps. In axial flaps, the blood supply is a single or recognized group of arteries, whereas random flaps are composed of numerous unnamed and smaller blood vessels. Different procedures call for different types of blood supply, which the doctor can further detail during a sit-down consultation.
Candidates for Flap Reconstruction Surgery
Men and women who are healthy and can endure a surgery with anesthesia may be eligible to undergo flap reconstruction surgery following tumor removal. There must be a healthy area in which to obtain the skin flap, free of skin disease and lesions as this new skin will be transferred to the face. Nonsmokers with good circulation may benefit the greatest from this type of skin graft as a new blood supply is imperative for the newly transplanted tissue flap to thrive.
Recovery from Flap Reconstruction Surgery
Bandages and dressings applied to the surgical site postoperatively are typically removed the following day. Swelling and bruising – two common side effects of any surgery – may result and peak in the first 24 to 72 hours following surgery but will subside within one week to 10 days. The application of cold compresses and elevating the head will help to minimize discoloration and inflammation. Pain or discomfort can be controlled with medications.
Flap Reconstruction Surgery FAQs
How long will the surgery take to perform?
The surgery will likely take one or more hours to perform due to the intricate nature of preserving or connecting blood vessels.
Will Dr. Mounsey treat cancer associated with the tumor if it is malignant?
Patients may come to Dr. Mounsey following the referral of an oncologist or dermatologist, but if the patient first sees Dr. Mounsey, he or she may be referred to a specialist. Dr. Mounsey specializes in facial plastic surgery and non-surgical procedures to improve patient aesthetics.
Is surgery required to remove a tumor?
Typically surgery is required to eliminate a tumor from the skin, with excision being the preferred method. In cases of smaller lesions, the doctor may be able to perform less invasive techniques to restore the skin to its original condition.
Will the surgery site require any postoperative treatments?
In some cases, the surgery site can benefit from treatments like laser therapy, microdermabrasion, and other types of skin refinishing to minimize the look of a scar. In other cases, the surgery and proper postsurgical care are sufficient for the most successful outcome.
Can Dr. Mounsey repair scar sites where other surgeons have removed a facial tumor?
The doctor can perform a scar revision surgery on the site of a previously excised tumor where obvious scarring results. Visit the Revesse scar revision page, or book a consultation for more information.
About Dr. Mounsey with Revesse of Toronto
Facial plastic surgeon Dr. Robert A. Mounsey, MD, FRCSC, FACS is a practitioner in Toronto, Ontario and serves the North York, Brampton, and Mississauga areas as well. The doctor is an expert in facial plastics and provides a number of minimally invasive and surgical procedures to help patients to improve their aesthetics.
Schedule a doctor-patient consultation with Dr. Mounsey to discover how to improve your appearance.
Reach the Revesse staff via telephone at 226.778.0671, or via email through the Patient Contact Form.