Trauma

Facial Fractures

A severe blow to the face can result in a fracture of a facial bone, with or without injury to the overlying tissues.  Mr David Morgan has undertaken specialist overseas training in dealing with these potentially complex injuries and is in charge of the Department responsible for treating these particular injuries at The Alfred Hospital, Melbourne’s busiest trauma centre.

The most common types of fractures encountered are those involving the nasal bones or the cheekbones.  Occasionally, the bones of the orbit, the upper or lower jaw, or the forehead can also be affected.  These fractures are usually the result of a motor vehicle accident, assault, or a sporting injury.

Fractures of these bones can result in a significant alteration to your appearance if they are not treated adequately.  Surgery to correct a fracture of the face will usually take place within two weeks of the injury – enough time to allow the swelling to go down and enable an accurate assessment of the injury, but also before the bones begin to heal in the wrong position. 

This type of surgery is performed under general anaesthesia, and is usually a day procedure.  Sometimes the bones can be returned to their correct position without making an incision on the skin, but most commonly several small, carefully placed incisions are needed to allow accurate reduction of the fracture.

Mr Morgan will discuss your options with you prior to your operation.

If you have sustained a facial fracture, please contact our office for an urgent appointment.

Post-Traumatic Deformities

After an injury, we all hope that our appearance remains affected as little as possible.  Unfortunately, some people may be left with an appearance that is not entirely satisfactory to them.  Plastic surgeons have many tools and techniques at their disposal that can be used in order to try and improve these results.

Poor scars can often be improved or revised, or re-aligned in order to make them less noticeable.  Contour abnormalities of the skin and underlying tissues may also be improved by injecting fat or other materials in to areas of depression, or by performing liposuction on prominent areas.  Bone abnormalities may require a bone graft or tailor-made implant to attain a more pleasing appearance. 

Mr Morgan has specialist overseas training in dealing with the residual effects of trauma, particularly in the area of the face and the underlying facial bones, and will give you a thorough and honest assessment of your concerns.

Remember that everyone is different, and that miracles are not possible.  Mr Morgan will discuss your individual situation with you, and give you a realistic impression of what can be achieved.

Wound & Scar Management

Plastic surgeons are experts in dealing with all types of wounds, and with a variety of dressings and techniques at our disposal we can promote effective healing of anything from a simple post-operative scar to a complex, chronic wound.

Wounds can result from surgery, accidents, or as a consequence of long-standing disease or disability.  By promoting rapid and effective healing we are able to maximise the cosmetic result of your wound, and allow you to return to your normal daily life as soon as possible.  This is particularly important for post-operative wounds, and for wounds in cosmetically sensitive areas such as the face.

Apart from expert wound-care, several factors can influence the outcome of your wound.  Maintaining a healthy diet and lifestyle will ensure that all the necessary building blocks for wound repair are present.  Keeping fit and undertaking regular exercise will improve the circulation and allow a healthy blood flow to the healing area, improving wound healing. 

Cigarettes contain many substances that are detrimental to wound healing and to your general health and you should stop smoking if at all possible.  Most elective plastic surgery procedures will not be undertaken until you have quit smoking because of the high risk of complications during your anaesthetic and in the post-operative period.

Many wounds will benefit from a period of rest or immobilisation and you should follow the advice of your doctor in this regard.  Wounds on the legs are usually slower to heal than wounds on the upper part of the body because of fluid accumulation that can occur.  Compression stockings or bandaging will be recommended in these instances to speed-up wound healing. 

Once your wound has healed, you will be given advice on how to look after your scar to achieve the best possible result.  This may include taping of the scars and/or gentle massage to the area to soften the scars more quickly.  Scars in sun-exposed areas need to be protected from the sun for up to three months to prevent them from becoming permanently pigmented.

Occasionally, some people will form bad scars, which can detract from an otherwise good surgical result, and cannot be anticipated by your surgeon.   These can be widespread, hypertrophic, or keloid scars. 

Widespread scars are scars that stretch sideways over time and usually occur on the back, breast, or abdomen.  This is due to the thickness of the skin in these areas, the time they take to strengthen, and the constant motion to which they are subjected. 

Hypertrophic scars are thick, red scars that develop in the first few months.  These will often improve with time and massage, but they can sometimes require additional treatment to achieve an acceptable final result.  This may include some form of pressure therapy, application of silicon gel sheeting, or in some instances the injection of a steroid solution in order to soften and flatten the scar.  Laser therapy can also be used to reduce the redness in the scar.  Sometimes a surgical scar revision is required to achieve a desirable result. 

Keloid scars are a severe form of hypertrophic scarring in which the area of abnormal scar formation extends beyond the bounds of the original wound.  These are uncommon, but can be very difficult to treat.  They will often recur after a scar revision.

Ultimately, the final appearance of a scar is largely determined by your individual genetic make-up and its anatomical location, with minor contributions to the result from the surgical technique and post-operative care.  Although previous scars can be used as a guide to the final appearance of a surgical scar, different areas of the body can heal differently and the possibility of a poor scar should always be considered when deciding to undergo a surgical procedure.

Facial Trauma

Our faces define our identity and reflect our personality.  They are the windows through which we interact with the world.  Facial trauma can result in permanent changes to our appearance or facial function and can affect the way the world sees us or the way in which we present ourselves to the world.  As plastic surgeons, we are trained to repair all types of facial injuries in such a way as to minimise as much as possible the long-term impact on appearance and function.  Injuries to the face commonly occur as a result of motor-vehicle accidents, workplace or household accidents, sporting injuries, or assault.  Children commonly sustain facial lacerations during play, or after a fall.

These injuries can be very distressing and our aim is to look after you in a caring and efficient manner, and to allow you to return to your normal activities as soon as possible.  Many of these injuries can be treated under local anaesthesia on the same day.  More significant injuries, and those in children, will usually require a general anaesthetic.  Scarring will always result after a laceration, but with precise repair and careful post-operative wound management we hope to make the scar heal with as little impact on your appearance as possible.