Pediatric Plastic Surgery Video Library
Learn about conditions and procedures related to Plastic and Reconstructive Surgery at Johns Hopkins All Children's Hospital with our surgeons, Alex Rottgers, M.D. and Jordan Halsey, M.D.
You can also watch the entire playlist on YouTube.
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This video provides an overview of the Johns Hopkins All Children’s Hospital Cleft Care treatment timeline, which provides a roadmap of when cleft-related surgical procedures are typically performed. The surgical procedures and timeline do vary depending on the size, location, and extent of the facial cleft, but this timeline is often useful for families to better understand how their child's complex facial difference will be surgically managed throughout infancy, childhood, and adolescence.
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In many cases, prenatal ultrasound and other imaging can detect facial clefts prior to birth. Families can benefit from meeting with their cleft surgeon prior to delivery to discuss the diagnosis of facial clefting, the surgical timeline, the importance of feeding and weight gain, and expectations moving forward. This video discusses the importance of prenatal consultation, when possible, and the typical questions that are addressed during these visits.
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This video provides an overview of the Johns Hopkins All Children’s Hospital Cleft Care treatment timeline, which provides a roadmap of when cleft-related surgical procedures are typically performed. The surgical procedures and timeline do vary depending on the size, location, and extent of the facial cleft, but this timeline is often useful for families to better understand how their child's complex facial difference will be surgically managed throughout infancy, childhood, and adolescence.
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This video provides an overview of cleft lip repair at Johns Hopkins All Children's Hospital, which may be performed in 1-2 stages depending on the type and extent of the cleft lip.
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This video discusses cleft palate, along with potential early feeding difficulties and how this can be managed with appropriate bottles and feeding assistance during infancy. The palate is important for both speech and feeding and it is essential for patients with a cleft palate to be managed by a cleft and craniofacial team, where a speech and feeding expert can address feeding difficulties and a qualified craniofacial surgeon can perform a durable and reliable palate repair. Cleft palate is typically repaired by one year of age in order to optimize speech outcomes.
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This video provides an overview of submucous cleft palate, which is a cleft palate camouflaged by an intact oral mucosa. The video discusses the clinical signs that can be present in these patients and the clinical importance of making the diagnosis of submucous cleft palate, as a submucous cleft can affect speech development and may potentially need surgical intervention.
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This video provides an overview of velopharyngeal dysfunction, a condition where the patient's palate (velum) and posterior pharynx (back of the throat) do not make complete contact during speech, causing speech to sound nasal and sometimes unintelligible. This is often diagnosed and initially treated by speech pathologists, though ultimately may require surgical management by a cleft and craniofacial surgeon in order to optimize speech.
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This video provides an overview of the alveolar bone grafting procedure to treat alveolar clefts in patients with cleft lip and/or palate. This procedure is typically performed in childhood and allows for the cleft region within the gumline to be repaired using bone harvested from the patient's hip.
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Lefort I surgery is a procedure that allows for the upper jaw, or maxilla, to be mobilized and advanced in patients with stunted jaw growth or repositioned in patients with facial asymmetry and other conditions. Jaw growth restriction can occur in patients with history of cleft lip/palate. This video provides an overview of this procedure, which should be performed in late adolescence once skeletal growth is complete.
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This video discusses the nasal anatomy present in patients with facial clefts and provides an overview of rhinoplasty procedures that can be performed to improve the nasal appearance in patients with cleft lip and palate.
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22q deletion syndrome - also called DiGeorge or velocardiofacial syndrome - is a genetic condition that can affect multiple systems throughout the body, commonly leading to cardiac, endocrine, immunologic, and craniofacial and speech abnormalities, in addition to psychologic and learning difficulties. This video provides an overview of 22q multidisciplinary care and underscores the importance of a team-based approach to address all relevant concerns for each patient.
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Pierre Robin Sequence is a condition where infants are born with a small and/or posteriorly positioned lower jaw, a large tongue that tends to collapse into the airway (glossoptosis), and airway obstruction. This video discusses this condition and the typical evaluation and treatment algorithm for infants born with this condition.
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This video discusses mandibular distraction, which is a surgical procedure performed to correct airway obstruction. This surgery is oftentimes indicated in early infancy to address Pierre Robin Sequence, where the jaw is too small and/or positioned too far posterior to allow for appropriate breathing and feeding. During the procedure, the jaw is intentionally fractured and then ""distracted"", allowing new bone to grow into the fracture site. The increased bone expansion following distraction can alleviate jaw-related airway obstruction and improve breathing and feeding.
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This video provides an overview of craniosynostosis, a condition where the craniofacial sutures prematurely fuse, causing growth to be inhibited in certain regions of the skull. This should be surgically corrected to prevent issues with craniofacial growth and development. This condition can be confused with positional plagiocephaly, where the skull appears misshapen but the sutures remain open and skull growth is not inhibited.
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Minimally-invasive suturectomy is a procedure that can treat craniosynostosis in patients diagnosed in early infancy. In patients with craniosynostosis, sutures that should remain open to allow for skull and brain growth close prematurely, creating an abnormal head shape. If left alone, the fused suture can lead to increased intracranial pressure and other complications. A minimally-invasive suturectomy, described in this video, can be performed to excise the fused suture. Following the surgery, the head shape is able to be molded over time with a helmet and the skull is able to grow appropriately.
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This video discusses open cranial vault reconstruction, which is a procedure that can treat craniosynostosis in patients with single or multi-suture craniosynostosis. In patients with craniosynostosis, sutures that should remain open to allow for skull and brain growth close prematurely, creating an abnormal head shape. If left alone, the fused suture can lead to increased intracranial pressure and other complications. Cranial vault reconstruction allows for skull remodeling, which corrects the abnormal head shape and allows the skull to expand with growth.
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Rhinoplasty is a procedure that can reconstruct areas of the nose and septum and allow for improved breathing along with an overall improved aesthetic appearance. This video discusses rhinoplasty, the typical preoperative evaluation, details about procedure goals, and postoperative course, along with answering many commonly asked questions about the procedure.
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Otoplasty is a procedure commonly performed during childhood to address prominent or abnormally shaped ears, allowing for improved ear position and symmetry. This is typically delayed until the child is around 6-7 years old to allow for them to take part in the surgical decision-making and also allow for the ears to grow to around 90% of their final size. This video provides an overview of the procedure and discusses the perioperative course of patients undergoing otoplasty.
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Microtia is a condition where part or all of the ear is absent at birth. This condition requires multidisciplinary management, with ENT addressing the hearing challenges and potential need for hearing aids during development and the JHACH plastic surgery team managing the reconstruction of the ear during early childhood. The ear can be reconstructed using a variety of techniques and oftentimes requires multiple stages for treatment. This video provides an overview of microtia and complex ear reconstruction.
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This video discusses ear molding, which is a non-surgical procedure that can correct abnormally shaped or prominent ear in young infants in the first few months of life. It involves the use of silicone conformers and surgical adhesive/tape to mold the ear shape over time, allowing for improvement in the shape and position of the ear.
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This video provides an overview of orthognathic, or jaw surgery, which can be performed to address functional and aesthetic concerns related to jaw and teeth alignment. Typically this is performed once skeletal growth is complete around late adolescence and is also performed in conjunction with orthodontic treatment of the teeth.
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Parry-Romberg syndrome is a condition where an area on the face slowly atrophies, or loses volume, over time. This can create an area of asymmetry that can be bothersome and can, in some cases, cause functional concerns. This video discusses this condition and its treatment, which is to replace the lost volume with fat and tissue harvested from the patient to replace the lost volume and improve symmetry.
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Fat grafting is a procedure where liposuction is used to harvest fat from the abdomen or thighs/buttocks, allowing for this fat to be transferred to another part of the body. This video discusses fat grafting as a procedure and its typical uses, including breast reconstruction and facial augmentation for asymmetry.
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The brachial plexus is a collection of nerves that provides innervation to the upper extremity and hand. This can be damaged in infants during birth and can also be damaged as a result of trauma in childhood and adolescence. This video provides an overview of brachial plexus injuries and underscores the importance of timely evaluation by our JHACH multidisciplinary brachial plexus and peripheral nerve team.
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Pulsed dye laser treatment is a procedure often used to treat the color and appearance of vascular lesions or scars that remain red for a prolonged period of time. It is performed under brief anesthetic and is repeated as needed to provide the best result. This video discusses pulsed dye laser treatment and common questions about the procedure and postoperative management.
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This video provides an overview of our JHACH multidisciplinary vascular anomalies team. Many infants and children are born with vascular appearing birthmarks or develop vascular lesions over time. Our vascular anomalies clinic is comprised of multiple subspecialists, including plastic surgery, hematology/oncology, and interventional radiology, who assess patients as a multidisciplinary team. This allows for vascular lesions and malformations to be treated with variety of modalities, including medications, sclerotherapy and embolization, laser treatments, and surgery. Our team meets weekly to discuss each patient and to formulate a unique treatment plan based on their diagnosis and imaging.
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Pediatric plastic surgeons are often asked to excise pigmented or vascular appearing lesions. These can be present at birth or present after birth and can require surgery and/or laser treatment. This video provides an overview of the typical lesions evaluated by pediatric plastic surgery and their management, along with postoperative recommendations to optimize the appearance and healing of surgical scars.
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Tissue expansion is a procedure that allows for slow expansion of skin, subcutaneous tissues, and sometimes muscle to allow for a large defect to be closed with expanded tissue. In this video, we discuss this 2-stage procedure, where initially a water balloon (expander) is placed in the area to be expanded and is filled slowly over time, allowing for the tissues to expand. In the second stage, the area of concern (oftentimes a birthmark or an area of scarring) is excised and the expander is removed. The expanded tissue is then used to close the defect.
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Breast reduction surgery is a procedure that can be performed to address debilitating back, neck, and shoulder pain related to large breast size in adolescents. This procedure can also improve their overall physical appearance and self-confidence and is the plastic surgery procedure with the highest patient satisfaction. This video provides an overview of breast reduction surgery and addresses many common questions and concerns related to the procedure.
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This video discusses breast asymmetry in adolescent patients and provides an overview of treatment options to improve breast symmetry in patients, including fat grafting, breast lift/reduction, and augmentation with tissue expansion/implant placement.
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Gynecomastia, or prominent/excessive of breast tissue in male patients, is a condition that prompts concern in many adolescent males. This typically occurs around the time of puberty and does not improve or resolve with time. This video discusses the evaluation and surgical treatment options of gynecomastia, along with the typical perioperative course and postoperative instructions.
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This video provides an overview of the management of congenital hand differences, which are typically addressed by 1 year of age. In some cases, newborns present with extra digits with a thin stalk, allowing for management with surgical clip ligation in the first few days/weeks of life. Most conditions, however, require operative management with postoperative cast placement.
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This video discusses what to expect on the day of their surgery at JHACH and addresses typical patient questions and concerns related to their procedure day.