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Melanie Cole (Host): Saint Louis University is one of the region’s leading centers for the treatment of diseases and conditions of the head and neck. The physicians of SLUCare who make up the university’s Department of Otolaryngology offer head and neck tumor surgery and facial reconstruction. My guest is Dr. Scott Walen. He’s an assistant professor at Saint Louis University and treats patients with traumatic injuries to the head and neck as well as airway problems, facial nerve paralysis, skin cancer, and more. Welcome to the show, Dr. Walen. Tell us why someone would need facial, plastic, or reconstructive surgery.

Dr. Scott Walen (Guest): Well, that’s a good question. I think when people come in to see me, they come in with one of two main problems. One of them is reconstructive surgery needs, which would include facial trauma, whether it’s nasal trauma, whether they break their jaw or anything in the mid-face. They could also have problems with skin cancer, which includes the removal of skin cancer and the subsequent facial reconstruction afterwards. Because anytime you get something removed in the face, you can have both cosmetic and functional problems, and so, we’re able to do that and fix those patients up. In addition, we deal with facial nerve paralysis as well from a variety of causes, and the second reason someone would come in to see a facial plastic surgeon is for cosmetic needs, whether it’s Botox, filler, anything requiring rhinoplasty or nose jobs, and then aging face cosmetics, which could include a blepharoplasty, face lifts, chin augmentation, and things like that.

Melanie: Well, Dr. Walen, if somebody has had a devastating experience—and something that happens to our face or head and neck really could be devastating—what you’re doing is really helping them improve their self-images well as helping them get through the situation. Tell us what kind of problems we might be talking about when we’re looking at head and neck cancers.

Dr. Walen: Well, with head and neck cancers, these patients come in, and they require large surgery. In some cases, there are smaller surgeries, but regardless, they’re usually left with both functional and cosmetic defects. So functional would mean problems swallowing or problems chewing or problems breathing through their nose or problems with their vision, and then cosmetic, often, some of these cancers require removal of the skin on the face. So using my training and the training of our head and neck surgeons, we’re sensitive to that, and we’re very able to reconstruct the face and give both a great functional and cosmetic result.

Melanie: Dr. Walen, what is recovery like for facial and reconstructive surgery? Is this like we’ve seen in the media—bandaged up the whole head, and then you open up the bandages and look in the mirror and see that the scars that you had or something are gone? Is there a lot of bruising and pain? Tell us a little bit about it.

Dr. Walen: Sure. Yeah, it depends. So if you get a skin cancer reconstruction, you’ll have an incision site that we would know how to deal with, that we know how to manage to optimize your scar. If you get a rhinoplasty or a nose job, whether it’s cosmetic or functional, you’ll have nasal swelling for a few weeks. If you get a large cancer resection and reconstruction, you’ll have a bit of a hospital stay and a bit of some downtime after that. If it’s a minor procedure, the downtime would be a few days; if it’s a major procedure, a few weeks.

Melanie: Now, tell us about some of the high quality cosmetic services that you offer. What do you do for people?

Dr. Walen: Sure. Well, patients are able to come in. We do have a multidisciplinary clinic, so they’re able to come in, and basically, we would hear their concerns and tailor each treatment to the individual patient concerns. And then using one of our products or surgical options, we’re able to really give the patient exactly what they’re looking, or whether to look better in their eyes or to look like a younger version of themselves. In addition, because I have training in head and neck and facial plastic and reconstructive surgery, I’m very sensitive and knowledgeable about some of the functional things that go along with cosmetic. For instance, you can do a rhinoplasty and completely ruin someone’s nasal airway, whereas if I am performing a rhinoplasty, I know about the airway and that physiology, so that’s less likely to happen.

Melanie: So that’s the advantage of having an otolaryngologist also doing your cosmetic surgery.

Dr. Walen: Absolutely, with any cosmetics of the face, the head, and the neck.

Melanie: Well, tell us about Botox and fillers. People are fascinated. You hear the stories in the media where people can’t then move or show expression. Give us the real deal about Botox and fillers.

Dr. Walen: Sure. Botox and filler, they’re much different. Botox paralyzes your muscles to help get rid of large wrinkles in the face, and filler provides volume to parts of the face that descend with age. They’re different products, but their similarities are that the procedures are very safe. They’re very quick. They have very little downtime. What we’re trying to do when we do Botox and filler, we’re trying to create a real natural result. So, having your face Botox’d and not being able to move or show any expression is not natural. Having too much filler put in your lips to your cheeks, so you look like you’re kind of puffed out, that’s not natural either. When I do Botox and filler, I’m looking for a very natural result. The ideal response would be if someone were to get Botox and filler, a few days later, one of their friends would comment if they were at the spa over the weekend, or maybe they changed their hair or something. It wouldn’t be obvious, but it does make a difference.

Melanie: Well, that’s great, because that’s certainly what you want when you’re intending to go in and get that. Now, also with the sun and Vitamin D and so many sunscreens and things out there, people are still having to have skin cancers removed. When they have those removed, does that leave a scar? Tell us about that post-removal reconstructive surgery and what’s involved.

Dr. Walen: Sure. Well, at SLUCare, we have a great relationship, multidisciplinary between dermatologists and then me, who does the reconstruction. What we offer, the one-day reconstruction. The dermatologist would remove the skin cancer, and then the same day, I would repair it. So they basically go home with a repaired defect, which is a huge advantage of coming to SLUCare. Basically, we tend to use adjacent tissue in complicated geometric patterns in order to cover the defects after the skin cancer has been removed. The results are quite amazing. They’re often left with very little scar. And afterwards, with various products, we’re able to really optimize that scar afterwards, and so, the patients leave very happy.

Melanie: Now, Dr. Walen, in just the last minute or a minute and a half left, tell us why people would come to SLUCare for their services for plastic and facial reconstruction.

Dr. Walen: Well, the main benefit of SLUCare is that we’re a real multidisciplinary group, and we treat each patient like they’re our own family. We provide high-quality, high-end services. We provide fantastic follow-up care and we’re always reachable, and I think we really give the patients a great experience. So I think that not only that, but our knowledge of the anatomy of the head and neck and face allows us to provide superior treatment for problems that are functional or cosmetic of the head and neck.

Melanie: Thank you so much, Dr. Scott Walen from SLUCare’s Facial, Plastic and Reconstructive Surgery Department. You’re listening to For Your Health with the physicians of Saint Louis University, SLUCare Physician Group. SLUCare is the academic medical practice of Saint Louis University School of Medicine. For more information, you can go to slucare.edu. This is Melanie Cole. Thanks for listening.