FAQs – About Pediatric Plastic Surgery

What is a Pediatric Plastic Surgeon?

A pediatric plastic surgeon is a Plastic & Reconstructive Surgeon who has chosen to sub-specialize in particular reconstructive procedures related to congenital, developmental, or acquired abnormalities in children. Usually, these surgeons have obtained additional training in specialized fellowships. For example after completing training in Plastic Surgery, an additional fellowship in craniofacial surgery would provide specialized knowledge of broad range of various facial birth anomalies and extensive training in the treatment of each anomaly.

What Types of Problems Do Pediatric Plastic Surgeons Treat?

Pediatric plastic surgeons repair birth defects, cancer, trauma, and abnormal growths throughout most of the body. Such abnormalities include:

  • Cleft lip & Palate
  • Craniosynostosis
  • Ear defects or missing ears
  • Large birthmarks
  • Large vascular abnormalities
  • Tumors
  • Fractured bones of the face or skull
  • Lacerations of the face
  • Misshapen breasts
  • Webbed fingers

Do Pediatric Plastic Surgeons Have Special Training?

Yes. A pediatric plastic surgeon undergoes traditional training to become a Plastic & Reconstructive surgeon:

Medical school

Five years of training in general surgery, or completion of a training program in general surgery, otolaryngology, urology, orthopedic surgery, neurosurgery, or a combined general surgery/maxillofacial surgery residency

2 – 3 years of training in Plastic & Reconstructive surgery

At least a 1 year fellowship in craniofacial surgery and/or pediatric plastic surgery

Is There a Board Certification for Pediatric Plastic Surgery?

There is not a specific board certification for pediatric plastic surgery, but there is a specific board certification for Plastic & Reconstructive Surgery. The American Board of Plastic & Reconstructive Surgery provides a board certification for all plastic surgeons.

How Should I Choose a Pediatric Plastic Surgeon?

When choosing a surgeon, you should research the surgeons training to ensure that they have the proper training in the procedure that your child needs performed. Confirm that they are board certified by The American Board of Plastic & Reconstructive Surgery. Review the state’s board website for any information regarding disciplinary actions.  Evaluate their performance on multiple review sites such as healthgrades.com and vitals.com. Once you have chosen a doctor, schedule an appointment to meet with them for a consultation.

Is Pediatric Plastic Surgery Covered By Insurance?

All insurance plans are different, and they all have their own policies regarding which procedures they will and will not cover. However, most pediatric issues that require reconstruction are typically covered by insurance. Some procedures may require a letter explaining the fact that the procedure is being performed to restore function, not just improve appearance. However, even procedures that are restoring appearance and not function should be covered by insurance companies since an abnormal appearance in a child can lead to psychological and social issues.

Is Pediatric Plastic Surgery Covered by Medicaid?

Similar to regular insurance, Medicaid has specific defined processes that it follows to determine what it will and will not cover. In addition, certain doctors may not participate with some or all of the Medicaid plans.

How Much Will the Surgery Cost?

  • The percentage you are required to play according to your plan
  • Co-pays
  • Deductible amounts
  • Out-of-pocket maximums

Your doctor’s office should be able to help you navigate the insurance process and determine how much you will be responsible to pay prior to your surgery. If the procedure is not covered by insurance (which is rare), the cost will need to be discussed with your surgeon.

Is Pediatric Plastic Surgery Considered “Cosmetic” For Certain Disorders?

There are some discussions of semantics that occur when deciding if a procedure is “cosmetic”. If a procedure is restoring a body part, such as an ear, back to its normal form without improving any functions, this could be considered cosmetic. However, many people use the term “cosmetic” as a broad statement to include either changes of normal anatomy to make them look more aesthetic or procedures designed for rejuvenation purposes such as a facelift. Once a clear distinction is made that a procedure is restoring anatomy to normal and not being performed for aesthetic or rejuvenation purposes, then it is more clear what the term “cosmetic” means. Using this definition, cosmetic procedures, such as microtia repair (ear reconstruction for a malformed ear), should be covered by insurance. However, an otoplasty (ear “pinning”) is more of an aesthetic procedure which is attempting to make normal anatomy appear more aesthetically pleasing. The word aesthetic is sometimes used synonymously with cosmetic, but the specialized association of plastic surgeons focused on procedures to improve beauty or rejuvenate is named The American Society for Aesthetic Plastic Surgery.

What Questions Should a Parent Ask Their Pediatric Plastic Surgeon?

It is important to ask the right questions during your consultation. When choosing a surgeon, you should feel comfortable with them as well as their ability to perform the procedure competently. Below are a list of some of the questions that can be asked to get a better understanding of the doctor’s experience and the environment in which the procedure will take place:

Questions for your Pediatric Plastic Surgeon

Are you board certified in Plastic & Reconstructive Surgery?

Did you complete fellowship training(s) focused on the type of surgery my child needs?

How many of these procedures have you performed in the past year? Past 3 years?

What complications can occur? How often do they occur for your patients?

Do you have before and after photos I can view?

Are there mothers of children that you have performed similar procedures for whom I can speak with?

Where will the procedure be performed?

Do you work with pediatric anesthesiologists? Do you work with the same anesthesiologists each time?

Is there a pediatric ICU in the hospital where the procedure will be performed? Have you ever had any issues there?

Will there be other doctors involved in my child’s care? Who are they? Why are they necessary?

Will there be any non-doctors, students, residents, or fellows involved in my child’s care?

Why is Pediatric Plastic Surgery Different From Adult Plastic Surgery?

It is important to understand that children are not just small adults. They have different physiology than adults, they are not able to communicate as effectively as adults, their tissues heal differently, and the size difference makes all medications and fluid shifts very different. The smaller and younger the child is, the more different they are from an adult. In addition, many of the anomalies that affect children are present at birth or a very young age. For this reason, adult surgeons are not familiar with the treatment of many of these anomalies. This is why special training is required not only by the surgeon but by the anesthesia team as well.

When is the Best Time For a Child to Have Reconstructive Surgery?

The timing of the surgery depends on the particular abnormality being corrected, the magnitude of the abnormality, the functional and cosmetic issues related to the abnormality, the age of the child, the health of the child, and the social level of the child along with many other factors.  For example, a child with a cleft lip may be operated on as early as day 2 of life with a second surgery around 3 months old. However, a child with a nasal deformity or a jaw abnormality without major functional issues may wait until their teen years to have a procedure. The entire scenario needs to be evaluated, and choices must be made with the parents or guardians as a part of the team and the decision process.

Can a Child Have General Anesthesia?

Yes. Children have general anesthesia all the time. However, the risks of having anesthesia vs not having the surgery need to be discussed with your doctor and anesthesiologist (if possible). The Society For Pediatric Anesthesia as well as The American Society of Anesthesiologists both have guidelines and advice on their websites related to anesthesia for surgery on children.

What Determines if the Pediatric Reconstruction Will Require Multiple Procedures?

Certain abnormalities require a staged reconstruction process in order to properly restore the anatomy in the best possible way. For example, the repair of a complete cleft lip and palate requires multiple procedures from 3 months of age through 18 years of age in some cases. Some procedures are not as clear, and they may need to be evaluated on a case by case basis. Naturally, everyone wants to have the abnormality corrected with the minimum number of surgeries possible, but in some cases, a significantly better outcome will be the result of multiple procedures rather than a single procedure. A thorough discussion with the surgeon and your participation in the decision process will lead to the right decision for your child.

Will Other Surgeons Be Involved in the Procedures Being Performed?

It is important to know who else will be involved in the procedure. Sometimes it is necessary to have a doctor from a different specialty involved for their particular expertise. An example of a procedure requiring two different types of surgeons is craniosynostosis repair. For these procedures, a Pediatric Plastic Surgeon and a neurosurgeon are both necessary. Sometimes, it is helpful to have two surgeons from the same specialty to assist each other. There may also be assistant staff such as physician’s assistants or students/residents present. It is important to understand who will be present and why they are necessary.

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