You'll find hundreds of files on cleft lip, cleft palate here on widesmiles.org.

This one is about: The "Other" Reasons - Why We Pursue Those "Purely Cosmetic" Procedures


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THE "OTHER" REASONS
Why we pursue those "purely cosmetic" procedures

by Joanne Green

It is not hard to justify our children's initial surgical repairs. When your darling baby sports a huge bilateral smile and food goes into the mouth and out the nose on a regular basis, we understand. The surgery is necessary. And though a great many of us "miss that big wide smile," we know in our minds and in our hearts that it is necessary.

But later, after the lip is fixed, and after the palate is fixed, we face a whole new hurdle - revision. The lip is together, but not quite straight. Or the nose is a little lopsided. Or perhaps later in the game, the midface has been stunted and appears to be "pushed in" from profile.

But the child functions wonderfully and we are accustomed to his look. How could we begin to think of changing that face we love so much? Such is what  I call "Momma vision" (Dads can have it too, by the way). It's that ability to see perfection in a still-imperfect face. It's what allowed me to look into the crib of my sleeping baby boy on the night before initial lip repair, gazing at his severely protruding premaxilla and gleaming white teeth (Joey was more than a year old at that time) and to think to myself, "It just looks like a bad overbite."  In retrospect, it didn't look like an overbite. It was a craniofacial deformity. But my Mommy-heart could not bear such imperfection in my child, so my eyes saw only a minor, acceptable problem.

The 16th century Italian doctor, Tagliacozzi, in explaining the need to replace noses lost in war by surgically and temporarily connecting the patient's arm to his face said, "We restore, repair and make whole those parts...which nature has given but which fortune has taken away - not so much that they could delight the eye, but that they may buoy up the spirit and help the mind of the afflicted."

Dr. Tagliacozzi understood what we have only recently understood ourselves - that in medicine the whole patient must be treated - body and spirit, and that the patient cannot function until he can function in society as well. The same is true even today, which is the reason our doctors are so relentless in their efforts to repair, reconstruct and revise.

Dr. Joseph G. McCarthy, Lawrence D Bell Professor of Plastic Surgery and Director of the Institute of Reconstructive Plastic Surgery of NYU Medical Center, in a recently publicized interview, explains the reason for such attention to detail.

"Unfortunately," says Dr McCarthy, "in all cultures we know of, people with facial deformities have been subjected to pity, ridicule, discrimination and rejection. Consequently, while most such people are of average or above average intelligence and have nothing functionally wrong, many cannot lead normal lives, get the education and jobs they would have had, or develop fulfilling family and social relationships. Because their faces frighten or repel, because their abilities too often are underestimated and their behavior is misunderstood, such people feel lonely, insecure, fearful and rejected."

Dr. McCarthy went on to explain that those most "victimized" are children, whose entire view of the world, and of themselves - their own self worth, capabilities and prospects - may be warped irrevocably.

Dr. McCarthy went on to tell of the amazing advances made in modern medicine that makes reconstruction possible. "We've come a long way. Traditionally, the kind of severely deformed patients we're transforming weren't treated. There was a basic attitude that it was 'God's will'. Besides, it was only after World War II that American Medicine began to move beyond life and death issues, and to become increasingly concerned with the QUALITY of life.

"It was only about 1970 that plastic surgery really came into its own, with the beginnings of craniofacial reconstruction and microsurgery." Dr. McCarthy pointed out that through the refining of techniques and increasingly
sophisticated technology, we are progressing far beyond what was once thought possible. "For instance," says Dr. McCarthy, "today we are successfully using on children, even on infants, procedures developed for adults. Who can say what we may be able to do in another decade."

So why do we do it? Do we subject our children to multiple surgeries because WE can't bear the deformity? I doubt it. Do we do it to protect others in our society from having to look at our child's atypical face? Hardly.

We do it for our kids and for their most significant audience of one -- the child who peers at that face each day in the mirror. We do it because, even if it is the face we could live with and love for the rest of our lives, we know that we aren't really the ones who will truly be living with it. We do it because we know that not everyone else in our child's life - including our child - will be looking at him through our eyes.

We do it for them.

----------- Parts of this article were excerpted from an article printed in NYU Medical Center News.


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