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Plastic and Reconstructive Surgery

Providing expert, personalized care for a variety of congenital disorders in infants, children, and young adults.


Duke Plastic Surgery has had a longstanding commitment to the care of children. Plastic surgery for children can have functional, cosmetic, and reconstructive implications. Often, appearance and function are closely tied together. What makes plastic surgery for children even more special is the fact that these conditions and their treatment can have a strong effect on confidence and self-esteem during critical periods of childhood and adolescent development. In addition, the work of plastic surgeons must also consider the constant change related to growth and how this could affect a surgery (and vice-versa). Plastic surgery for children requires not only exceptional technical skill, but also care and understanding of the child’s overall wellbeing.

Duke’s Cleft Team was one of the first established multi-disciplinary centers in the country, established in the 1960’s. However, facial clefts and craniofacial conditions are only some of the problems seen daily by Duke’s pediatric plastic surgeons and craniofacial surgeons. Plastic surgery problems in children and young adults can affect all areas of the body. Some of the conditions seen are common and some very rare.  Some are very straight-forward, and others extremely complex. It is never easy for a parent to make the decision for their child to have surgery. Big or small, regardless of the problem being treated, it is important for families to know that we consider every every patient and every problem equally important. 

Duke Plastic Surgery has specific expertise and dedicated treatment programs in a number of areas including: cleft lip & palate, craniosynostosis, facial paralysis, cosmetic/functional nose surgery, ear deformities, congenital hand deformities, birth-related brachial plexus palsy, hemangiomas and vascular lesions, traumatic injuries, and skin conditions such as congenital nevi.

The Cleft and Craniofacial Team at Duke Children's Hospital & Health Center is a national leader in the care of children and adolescents. The Duke Cleft and Craniofacial Team has been designated the highest possible status level by the American Cleft Palate Association and holds both the CPT designation of Cleft Lip and Palate Multidisciplinary Teams as well as the CFT designation for complete Craniofacial Care. The Duke Cleft and Craniofacial Team is further distinguished as an official ACPA Affiliated Team.



Treatments

The types of problems seen by our pediatric plastic surgeons and craniofacial surgeons at Duke Children’s Hospital are either congenital (meaning that the child was born with the problem) or acquired (a problem that occurred sometime after birth). Adults born with some of the same conditions may also be seen by our specialists, but usually in our adult facilities.

Duke Plastic Surgery provides leadership in four unique interdisciplinary care teams in which multiple physician experts and related specialists work together to provide coordinated and complete care for the most challenging conditions.

Programs

Duke's experienced surgeons offer comprehensive care for children with both congenital and acquired defects. Click on the links below to learn about the specifics of each program.

Cleft Lip and Palate
The most modern treatment program and techniques offered by one of the earliest-established cleft multidisciplinary teams in the country.

Craniofacial Program
Brings together specialists from several disciplines to treat children with Craniosynostosis and other craniofacial conditions.

Facial Paralysis and Reanimation: "Smile Surgery"
A specialized program to restore the ability to smile for patients with facial paralysis.

Commonly Treated Conditions

Duke pediatric plastic surgeons are experts at treating complex facial deformities as well as the more common problems that are noted at birth or as a result of accident or injury. Some examples of conditions commonly treated by our pediatric plastic surgeons include: 

Ear Abnormalities
There are many types of ear malformations, including microtia (a small undeveloped ear) and anotia (absence of the ear). These conditions can occur with other facial growth problems in some cases.  Prominent ears are common and are treated using cosmetic surgical techniques that have evolved and improved greatly over the years.

  • Prominent Ears
    For children with prominent ears, otoplasty is used to set prominent ears back closer to the head or to reduce the size of larger ears. Otoplasty is the most common cosmetic procedure among children. 
  • Microtia
    Microtia is a congenital condition in which the ear is not fully formed. This condition is typically treated with reconstructive surgery. Treatment is staged and generally begins after age seven. 

Nasal Surgery
Nasal surgery (rhinoplasty) is done to treat nasal obstruction, to correct appearance, or some of both.  Nasal obstruction can be caused by a number of problems, including a deviated septum. 

Rhinoplasty procedures are typically performed after children are mostly done growing. For girls this can be after 15 and for boys 16-17. Rhinoplasty procedures are also performed for children born with facial deformities like cleft lip/palate, and in these cases, are sometimes performed earlier. 

Cysts and Masses
Pediatricians sometime notice irregularities or bumps that may seem concerning.  Children with concerning bumps are seen frequently by our pediatric plastic surgeons.   These abnormalities most often are completely safe but may require removal.  The most common include dermoid cysts, pilomatricoma, and vascular birthmarks.

  • Dermoid cyst are growths that appear at birth on the skull or facial bones. They often grow slowly over time and cause little pain.
  • Pilomatricoma is a hard mass in the fat layer of skin that often appears on the face or arms.
  • Vascular birthmarks and hemangiomas are often red or purple spots that appear on the skin and are caused by vein abnormalities.  Read more about these lesions below. 

Hand Conditions
Our pediatric plastic surgeons treat hand abnormalities caused by trauma as well as congenital abnormalities.

  • Syndactyly is a condition in which two or more fingers are fused together. Most commonly, the fusion only affects the skin between the fingers. However, fusion can involve the bone as well.
  • Duplication of fingers or thumbs is common. This simplest form is a small finger duplication on a narrow stalk of skin which has no significant involvement of the bone. These are easily removed--our preference is to remove these after age 6 months with under a brief mask anesthetic. Duplication can be more complex, such as in thumb duplication, which requires a more intricate surgery. 

Skin Abnormalities
Skin lesions in children are common. Our pediatric plastic surgeons work with dermatologists here at Duke and in the communities to diagnose and treat a variety of skin lesions.   

  • “Nevus” is another word for a mole, and there are many different types of nevi. Nevi can be present at birth, or they can occur later. Not all nevi need to be removed, but together with our dermatologists, we can help families make this decision. Nevi can be quite large and can even occupy a significant percentage of the body surface. Treatments vary widely according to the size and location of the lesion(s).
  • Vascular birthmarks are very common. There are many specific types of vascular birthmarks, including hemangiomas and a variety of other malformations. It is very important to distinguish the type of vascular birthmark because the treatment can greatly vary depending on the diagnosis. Once the diagnosis has been made, the majority of vascular birthmarks are straightforward and can be treated. Treatments can range from observation alone, medications to shrink the lesions, injection treatment, laser therapy, to surgery. For conditions that are more complicated, Duke’s pediatric plastic surgeons participate in one of the largest multi-disciplinary vascular malformations teams in the US. This team includes nearly 20 MD specialists who regularly meet to discuss challenging cases and to recommend the right treatment.        

Traumatic Injuries
Our pediatric plastic surgeons offer compassionate care for patients with traumatic injuries including lacerations, fractures, dog bites, facial or nasal injuries, and problematic wounds.

 


Physicians and Staff

Physicians

Name Areas of Special Interest
Jeffrey R. Marcus, MD Craniofacial surgery for children and adults including cleft lip/palate and craniosynostosis; rhinoplasty for cosmetic and/or breathing issues; microsurgical facial reanimation for facial paralysis; microsurgical repair of brachial plexus injuries in infants; broad scope of pediatric plastic surgery including skin conditions, congenital hand surgery, ear reconstruction; assistance to families of internationally adopted children with cleft lip and palate
Pedro E. Santiago, DMD Orthodontics for patients of all ages; Invisalign and clear braces; presurgical orthodontics for orthognathic surgery and dental implants; presurgical orthopaedics (nasoalveolar molding) for cleft lip, palate, and other craniofacial disorders


Alexander Allori, MD, MPH (arriving August 2014)


Clinic Hours and Locations

Clinic hours and locations vary by physician. Please contact your doctor's office to clarify the location of your appointment if there is any question.

Duke Children's Hospital & Health Center
2301 Erwin Road
Durham, NC 27710
Tel: 919-668-4000

Duke University Hospital
2301 Erwin Road
Durham, NC 27710
Tel: 919-684-8111

Duke Aesthetic Center
3475 Erwin Road
Durham, NC 27710
Tel: 919-681-8555

Orthodontics/Pedro Santigo, DMD
3115 Academy Road
Durham, NC 27707
Tel: 919-489-2394


Appointments and Contact Information

To book an appointment with a specific physician or clinic, please use the following numbers. You will also find additional contact information on the specific program pages for our multidisciplinary programs.

  • For newborn patients with cleft lip and palate or to reach the Cleft Team coordinator, call the Duke Cleft Line at 919-684-3815.
  • For urgent concerns outside of normal business hours, please call the Duke operator at 919-684-8111 and ask to speak to the plastic surgeon on call:
    • Dr. Jeffrey Marcus: 919668-3110
    • Dr. Gregory Georgiade: 919-684-2854
    • Dr. Pedro Santiago: 919-489-2394