Why would a child or adolescent need plastic surgery?

  • A cleft lip is just one of many reasons why you may want to consult with a pediatric plastic surgeon.

    A cleft lip is just one of many reasons why you may want to consult with a pediatric plastic surgeon. Stock Photo

  • By Dr. John Smetona, Pediatric Plastic Surgeon, Advocate Children's Hospital

    By Dr. John Smetona, Pediatric Plastic Surgeon, Advocate Children's Hospital

By Dr. John Smetona
Advocate Children’s Hospital
Updated 1/5/2023 6:03 PM

You may not associate the phrase "plastic surgery" with children, but pediatric plastic surgeons play a critical role in caring for children and adolescents with a wide range of conditions.

Some of the more minor conditions we treat include ear malformations/deformities, skin tags, moles, "lumps" and "bumps" and head shape anomalies. The most common reason we see kids is for concern about their head shape; while the "Back to Sleep" campaign has reduced the incidence of sudden infant death syndrome, it has led to a dramatic increase in the frequency of abnormal head shapes.


Other very common conditions we treat are congenital hand or foot anomalies -- often having an extra finger or toe or having multiple digits connected to each other.

Q: What differences in an ear might require a pediatric plastic surgeon?

A: Ear anomalies cover a wide spectrum, from being prominent on the mild end to completely absent on the severe end. The treatment depends on the condition -- prominent ears can be molded in infancy or surgically treated (otoplasty or 'ear pinning') at an older age, while an absent ear may require more involved surgery using cartilage.

Q: What are some of the more complex conditions that require a pediatric plastic surgeon?

A: These include craniosynostosis, in which the bones of the skull fuse prematurely, cleft lip and palate, breast anomalies and jaw problems ('malocclusion').

Q: What can be done for a malocclusion "bad bite?"

A: The jaws can be moved surgically to be in a better position. There are three common reasons a patient may be a candidate for jaw surgery:

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Developmental: The upper and lower jaws grow in such a way that they don't meet properly or just aren't in the right place. This can lead to difficulty chewing, pain in the jaw joint and/or muscles, unfavorable appearance and sleep apnea.

Malocclusion caused by a medical syndrome or trauma: The most common syndrome associated with abnormal jaw growth is cleft lip and palate. Many patients with clefts ultimately require jaw surgery. Injuries to the jaw can also heal in poor position or disrupt future growth.

Breathing issues: This can occur in patients of any age but is most common in infants or adults. In infants, breathing issues that may require jaw surgery are typically caused by the lower jaw being underdeveloped. In adults, weight gain is often involved, especially if the patient has a relatively small jaw. Soft tissue can crowd the throat, narrowing the airway and ultimately cause obstructive sleep apnea. This can be treated by pulling the jaws forward, which takes the soft tissue of the throat with it, opening the airway. This is also usually a cosmetically favorable change.

Regardless of the complexity of a patient's condition, our experienced multidisciplinary team is equipped to provide compassionate, personalized care using innovative treatment options.

• Children's health is a continuing series. Dr. John Smetona is a pediatric plastic surgeon practicing at Advocate Children's Hospital. Visit advocatechildrenshospital.com/services/plastic-surgery for more information.

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