Facial Expansion: A Blueprint for Coverage

The benefits of tissue expansion go unrealized if flap design and coverage concepts do not exist in preoperative thinking. Without proper analysis, the surgeon will likely burden the patient with more expanders than necessary. Tissue coverage needs can be simplified in forms of triangles and rectangles to determine expanded tissue advancement. Single or double back-cuts allow use of all the expanded tissue. Furthermore, early subtotal excisions, especially in children younger than 4 months, can reduce the number of expanders required. With methods presented herein, the face can be resurfaced with better color and less distortion. Eyebrows should be maintained and positioned by keeping the lower frontalis muscles intact. Cheeks can be covered with a large Schrudde design, and color can be improved by using upper neck skin preferentially over lower neck harvest. Laser hair removal allows larger swaths of forehead to be covered by hair-bearing scalp tissue. Prior incisional delay can expedite success with no tissue loss. The results speak for themselves when surfaces are covered with large, expanded flaps that are expeditiously harvested.