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Marc J. Elkowitz, M.D., F.A.C.S  -  Harry H. Intsiful, M.D., F.A.C.S - Sophie Bartsich, M.D., F.A.C.S

 Aksana Jensen, Aesthetician

A hemangioma is a benign vascular tumor that may be present at birth or appear shortly after birth. It may grow rapidly from a small pin sized red dot to a large mass (tumor) during the first few months of life. The tumors are composed of small blood vessels (capillaries) that may ulcerate causing pain or may even bleed. Most fade away to a fleshy colored fatty mass in later childhood (5-7yrs old) but often require surgical excision to improve the contour of the affected area. Medical treatment may involve a medication called propanolol to induce regression in areas where surgical treatment is not optimal. Laser treatment can also be used but since it only penetrates about 1mm, it is not optimal for thicker tumors.

Congenital Nevus
A congenital nevus, “mole”, “birthmark”, is a nest of pigmented cells called melanocytes located underneath the skin causing a discoloration. A congenital nevus is present at birth and carries a higher rate of possible conversion to the cancer melanoma. Treatment involves either consistent monitoring at least on a yearly basis with your dermatologist or a complete surgical excision by your surgeon. Most can be removed surgically leaving a thin linear scar. In some instances, if very large, excision may require tissue expanders (balloons) placed to stretch the normal skin to reconstruct the area after the excision, or even several excisions (serial excisions) to remove the nevus in its entirety.

Dermoid Cyst
A dermoid cyst is a cheesy-like embryologic substance that may be buried beneath the skin typically in the eyebrow and scalp area that may be noticed soon after birth. If present in the midline by the nose, a MRI may be needed to look for intracranial involvement (skull defects). Surgical excision is fairly simple and scars may be placed in non-apparent areas to improve the aesthetics. These “tumors” are removed fairly early (around age 6 months) to obtain a tissue diagnosis and to prevent the possibility of rupture and infection.

Skin Tags
Skin tags or branchial remnants are small skin appendages that are leftover tissue from the fetal stages of development that may be present anywhere along the face, ear or neck. Surgical excision is recommended to not only improve aesthetics but also to reduce the incidences of possible infection of these structures. These structures may be a sign of Hemifacialmicrosomia, and a thorough exam by a craniofacial surgeon is often necessary.

Cleft Lip
A cleft lip is a defect (gap) between the lip and or nostril edges that may occur commonly in up to 1/1000 newborns. It may often be diagnosed on prenatal ultrasound around 20 weeks of gestation. Surgical repair of the skin, mucosa, nose, and lip muscle occur around 3-4 months of age and may require presurgical molding by a process called NAM. Good aesthetic and functional results can be obtained, however, minor revisions may be necessitated when your child is older (particularly in the nose) due to the unpredictability of facial growth.

Cleft Palate
A cleft palate is a hole in either the hard and/or soft palate due to failure of these structures to fuse in the midline during fetal growth. This hole creates a connection (fistula) between the nose and mouth, allowing food to regurgitate through the nose, making feeding at times difficult. Specialty bottles and nipples are available to help your child feed normally prior to surgical repair (1 year of age). Surgical repair is delayed until one year to allow your child to grow, allowing a better chance of a successful repair. Most importantly, during the surgery, the muscle (levatorpalatini) is repaired, allowing for normal speech by sealing off the nose from the mouth during muscle contraction. 20% of children require a secondary procedure to improve speech, when this muscle fails to work properly even after repair (VPI).


Pediatric Skull Anomalies
Craniosynostosis is an early closure of the growth plates of the skull leading to deformations in the forehead , cranial vault and eye sockets. Early fusion of one of these sutures can lead to increased pressure on the brain (ICP) and surgical correction is the recommended treatment, usually around age 6-9 months. A 3D-CT scan may be required to aid on the diagnosis and treatment planning. Consultations with a craniofacial surgeon, opthomologist, neurosurgeon and geneticist are typically performed for a multi-disciplinary approach to treatment planning.

Deformational Plagiocephaly causes a flattening on the back part of the head (occiput) and possibly even a protruding forehead and anterior ear position that is the result of your infant lying on one side for a long period of time. Sometimes this can be the result of neck muscle spasm (torticollis) which may require physical therapy. A rounder head can be reformed by repositioning (tummy time) or sometimes placing a helmet to offload the pressure on the flat part of the head. If a helmet is elected, a treatment time of 23hr/day for 4-6 months is often required. Sometimes this diagnosis is confused for craniosynostosis (early growth plate closure of the skull) and a consult with a craniofacial surgeon is important to properly evaluate your child.

Pierre-Robin Sequence
A small lower jaw (mandible) can lead to abnormal tongue positioning causing a cleft palate which may obstruct the airway in some newborns. The small jaw prevents the tongue from lying forward and can be fatal if unrecognized. A craniofacial surgeon can help the problem by bringing the lower jaw forward by a process known as Mandibular Distraction.