Craniofacial Surgery

Craniofacial surgery involves reconstruction of the face, jaws, or skull in patients with defects from birth, trauma, cancer, or other reasons. At Bay Area Esthetics Plastic Surgery our goal is to optimize both esthetics and function for our craniofacial patients.

• An ideal esthetic outcome corrects the deformity so that it no longer draws attention, allowing others to see you or your child for who they are and not their differences.
• An ideal functional outcome relieves patients of any feeding, speech, breathing, or head growth difficulties they may have as a result of their craniofacial deformity and improves their psychological and social well-being.

• Dr. Pourtaheri is a craniofacial surgery specialist with an advanced understanding of facial function and esthetics. Craniofacial procedures are some of the most gratifying procedures that he performs to improve the lives of his patients.
• Dr. Pourtaheri has a PhD in medical modeling and imaging. He uses extensive photography and in some cases radiography to analyze your face and skull from various angles. He may also use state-of-the-art 3-D virtual surgical planning to provide you with a safer, more accurate, and lasting outcome.
• Dr. Pourtaheri is an advocate for multi-disciplinary care and understands that better outcomes are achieved by working as a team. We will coordinate your care with experts in related fields to help you get the best outcome and make your journey as seamless as possible.
• Dr. Pourtaheri is one of the few plastic surgeons who received extensive training in craniomaxillofacial surgery alongside plastic, ENT, and oral surgery experts. During his six years of residency, Dr. Pourtaheri performed cleft lip and palate surgery, jaw surgery, cranial vault remodeling / reconstruction, craniofacial distraction, head and neck reconstruction, and facial trauma management.
• Dr. Pourtaheri completed a craniofacial fellowship and trained with some of the world’s leading experts in craniofacial surgery including Dr. John Persing and Dr. Derek Steinbacher further developing his skills in craniofacial and oral surgery.
• Dr. Pourtaheri has given numerous national and international presentations himself, and has published several articles on craniofacial surgery in peer-reviewed scientific journals. He is an editorial board member for the Journal of Craniofacial Surgery, reviewing works submitted by others.
• Dr. Pourtaheri was the former Director of Craniomaxillofacial Surgery at Indiana University, providing care to patients with cleft / lip and palate, face, jaw, and skull deformities from all over the state.

Craniofacial surgery can help you or your child with their deformity. Often, if a part of the face, oral cavity, or underlying bones appears abnormal it also does not function normally. Surgically correcting the anatomy can therefore restore function (for example, improve speech and feeding in cleft palate patients). To discuss having us provide you or your child with craniofacial surgery, please contact us through our confidential online form or call / text 415-523-5235 to schedule a consultation with Dr. Pourtaheri.

Craniofacial surgery can be performed at various stages of a patient’s life. Procedures performed while your child is still growing are often performed to prevent functional deficits and encourage normal development of speech and feeding or brain growth. If you have questions about the ideal timing for a procedure, please request a consultation or call / text 415-523-5235 to schedule an appointment with Dr. Pourtaheri.

Common reasons why patients pursue craniofacial surgery include having:

• Facial or skull injuries
• A cleft lip and or palate
• Other facial cleft
• Ear deformity
• Nasal or other facial deformity
• Head shape abnormality or restricted head growth
• Restricted or asymmetric jaw growth

If you have a craniofacial deformity, health insurance will likely help cover the cost of your procedures. We are happy to help you navigate this process. If you have questions about your eligibility for a procedure, please contact us online using our confidential online form or call / text 415-523-5235 to schedule a consultation.

Before your first visit, you will be asked to complete an intake form to document your personal and medical history, prior surgeries, dental work, medications, and allergies.

At your visit we will review your concerns and goals. We will also want to learn more specifically about any prior craniofacial or dental procedures you received. We will examine your overall face, oral cavity, and head from various angles. The examination will not be uncomfortable. A CT (computed tomography) scan may be used to evaluate the area of concern and help plan the surgery.

We will work closely with your other team members (pediatrician, speech pathologist, audiologist, ENT, neurosurgeon, orthodontist) to obtain your records and discuss the plan, or we may refer you to some of our trusted colleagues if you do not currently have a team of experts helping you already. We will also take photographs that will be used to plan your surgery and track your changes after. You will have a chance to discuss the plan with Dr. Pourtaheri prior to surgery.

Dr. Pourtaheri is meticulous and scientific when it comes to planning and performing craniofacial surgery. He spends time before surgery making numerous measurements and performs 3-D virtual surgical planning, when applicable, to make the surgery safer, quicker, and more accurate. The procedure time can vary depending on the approach, number, and complexity of necessary changes.

• Cleft lip, palate, and nose surgery – Dr. Pourtaheri offers cleft lip, palate, and nose surgery for patients born with a cleft through these areas. Whether you have a child with a cleft or currently pregnant with one, we will go over the timing and options for your child’s treatment journey. The initial cleft lip repair typically occurs in the first few months of life, while a palate repair first occurs closer to one year of age. Secondary procedures are commonly needed and can help refine your child’s appearance or speech. Dr. Pourtaheri also provides revision cleft surgery. This refers to cleft lip or palate surgery performed on patients who have had a previous cleft surgery and have persistent problems. This requires careful planning to correct the area of concern and maximize esthetics, while minimizing the risk of complications.
• Skull reshaping / reconstruction (Cranioplasty or Cranial Vault Surgery) – Skull reshaping or reconstruction is offered to patients with skull deformities. This can be due to missing a portion of the skull, having a skull that is too big, or having a skull with abnormal or restricted growth. Reshaping can be achieved using in a variety of techniques. If you have an infant with abnormal or restricted skull growth or craniosynostosis, we will follow your child’s head growth / shape, work with a neurosurgeon, and potentially require a low-dose CT scan to confirm the diagnosis. Once the diagnosis is confirmed and the severity is determined, we will discuss the risks and benefits of undergoing cranial vault remodeling. Your surgery will be performed alongside a neurosurgeon to ensure the brain is protected throughout the case. After surgery, your child will typically stay in the ICU for a night and then a regular hospital bed for a couple days before going home. If you are missing a portion of your skull, we offer cranioplasty using a variety of implant materials including (PEEK, or titanium) or your own bone (rib or skull) in order to reconstruct the skull. We perform these procedures with a neurosurgeon in order to maximize safety.
• Jaw surgery – Jaw surgery (orthognathic surgery) and jaw lengthening (mandibular distraction) can be used to correct sleep apnea or breathing disorders in both children and adults. Common reasons for needing a jaw procedure is being born with a small jaw (Robin-sequence, micrognathia), having asymmetric jaw growth (hemifacial microsomia, hemifacial hypertrophy, or unicondylar hyperplasia), or having tongue-based airway obstruction. These problems can be corrected with jaw surgery in a single stage, or sometimes in 2-stages with distraction osteogenesis. Please see our page on jaw surgery for more information, or call us to schedule an appointment.
• Craniofacial distraction – Patients with abnormal bones of the skull, face, or jaws may benefit from distraction osteogenesis. This involves gradually lengthening the bones with a distraction device, allowing the body to form new bone as the bone is stretched apart. After a period of consolidation (letting the bone solidify), a second stage is needed to remove the distraction devices. This technique can add safety to a jaw or skull procedure by reducing blood loss and making the initial procedure shorter, as well as provide a means for dramatic expansion of the craniofacial skeleton beyond what is possible in a single-stage reconstruction procedure. Dr. Pourtaheri offers a full range of distraction procedures to reshape and lengthen bones of the face and skull.
• Ear reshaping (otoplasty, microtia) – Ear reshaping surgery, or otoplasty is commonly performed after the age of 5, when the ear is close to its full size. This procedure can involve reshaping or reduction of the existing cartilage within the ear to provide an optimal shape and size. At Bay Area Esthetics we also provide ear molding. This in-office procedure involves creation or assembly of an ear molding device to help reshape your infant’s ear. Ear molding is most successful if completed within the first two months of life, while maternal estrogen is still present in your baby’s bloodstream. For patients missing most or all of their ear (microtia), we can provide ear reconstruction. This procedure will involve carefully removing some rib cartilage, shaping it into an ear, and placing it underneath the skin. A second stage is often needed to complete the reconstruction.
• Facial reanimation – Smile surgery, or facial reanimation, is a procedure we offer for patients who have a facial nerve palsy. Facial nerve palsies can be temporary or permanent, and are usually a result of a birth defect, cancer, or trauma. The procedure we perform can help patients close their eyelids better to protect the eye, lift the corner of your mouth at rest to minimize drooling, and provide a more symmetric smile. In surgery, we will use your own muscles, fascia, and nerves to restore these vital functions. You may need physical therapy after surgery to maximize your outcomes.
• Facial Fracture Reconstruction – Please see our page on reconstruction for more information about facial fracture reconstruction.

We can perform your craniofacial surgery in San Francisco or Sonoma County based on your preference and age. Immediately following surgery we will take you to a recovery area or intensive care unit to be cared for. Depending on the procedure, patients may go home the same day or stay in the hospital one or more nights.

Patients are given antibiotics on the day of surgery and may also need to take them after surgery. We also prescribe pain medications to limit discomfort. We may recommend a modified diet or feeding instructions to help with healing for several weeks. You will receive care instructions before and after surgery and have plenty of time to ask questions.

After surgery, your face, head, and neck may be bruised, swollen, and sore for a couple weeks. It is best to sleep with your head elevated on 2 or more pillows and not strain yourself to reduce swelling during this time to minimize swelling. Regular activity is encouraged, starting the morning after surgery.

We will examine and check on you while you are in the hospital, and plan to see you again in 1-2 weeks after you leave the hospital. We will schedule additional visits to check on healing progress; some of these can be done virtually if you live out of town. If you are ready to take the next step and learn more about craniofacial surgery to improve your function and appearance, please contact us online using our confidential form or call / text 415-523-5235 to schedule a consultation with Dr. Pourtaheri.