FROM HEAD TO TOE
Fig. 4a
Fig. 4b
Fig. 4c
unit principles, leaving flat, scarred, featureless lips and a life-long
stigma. Dr. Millard carefully analyzed and measured the normal
side aesthetics, and then transferred these features to the cleft side
repair (fig. 4a). In doing so, he placed incisions along lines between
lip aesthetic units, leaving less noticeable scars (fig. 4b, 4c). The im-
proved results have now benefitted millions of children worldwide,
reducing the stigma of this common condition. I had the pleasure
of serving a fellowship with Dr. Millard, and subsequently applying
the lessons learned as a volunteer surgeon with Operation Smile,
a charitable organization whose teams travel worldwide to apply
and teach cleft lip and related reconstructive procedures. I found
the human and cultural lessons we learned in these and similar
missions to be so inspiring as to be life-changing. In this manner,
we benefitted differently, but as much as the children we served. cultures into large sheets the size of notebook paper, an important
need for replacing skin of extensively burned patients. Key to the
process was use of the recently discovered Epidermal Growth Factor,
a protein that stimulates skin cell multiplication. The project was
most successful. However, the number of patients here that were
so extensively burned as to need this breakthrough were too few
to justify the personnel and production costs. Now, commercial
labs using a similar process serve burn units nationwide, and they
have replaced local efforts such as ours. Shortly after his fellowship,
Dr. Brown used his knowledge of growth factor biology to create
cosmetic skin-care preparations. He founded a highly successful
company, and a line of cosmetics, RéVive. Thus, his success in
aesthetics came from a reconstructive foundation.
RECONSTRUCTIVE PRINCIPLES APPLIED TO AESTHETIC USES Plastic surgery research is producing an expanding number of new
techniques that involve fusion of aesthetic and reconstructive or
wound biology principles to achieve better outcomes. These efforts
will surely bring substantial benefits to tomorrow’s patients needing
reconstruction or seeking aesthetic enhancements.
A prime example of reconstruction serving aesthetics came from
the UofL Surgery program. In the 1980s, I was asked by Hiram Polk,
MD, to be a faculty mentor to a bright, energetic surgical graduate,
Greg Brown, MD, who was appointed as fellow in the Price Institute
of Surgical Research. Dr. Brown wished to establish a burn care
program of growing postage-stamp sized skin biopsies in laboratory
THE FUTURE
Dr. Tobin is a professor at the University of Louisville School of Medicine, Department
of Surgery, Division of Plastic and Reconstructive Surgery. He practices with UofL
Physicians – Plastic and Reconstructive Surgery.
Fig. 2
Legend to Figures
Fig. 1 Aesthetic units of the upper lip and nose.
Fig. 2 Aesthetic units of the full face.
Fig. 3 Facial recognition algorithm patterns.
Fig. 4 The Millard Rotation-Advancement cleft lip repair.
a. Designing a repair pattern based on normal-side aesthetic features.
b. Incising and moving the flaps of the repair.
c. Finished repairs, with balanced, aesthetic form created.
APRIL 2020
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