SingaporeMotherhood | Parenting

May 2014

Smile, Baby, Smile: Reconstructive Surgery for Children

No parent wants their child to have to go under the knife but sometimes, doing so is necessary and might even benefit the young one. Plastic surgery is one such example, where babies and children undergo medical treatments – although not necessarily an operation – for a positive change.

This happens in instances where there is visible disfigurement on the child which, in the long run, could affect not just the child’s development, but also his confidence and self-esteem.

The reasons why a child would need plastic or reconstructive surgery could be congenital, or otherwise. Examples of such scenarios include instances when the child has a cleft lip/palate, birthmarks, burn scars, ear/nasal deformities, or vascular lesions.


“Plastic surgery can be broadly divided into reconstructive surgery, which corrects abnormalities, and cosmetic surgery, which enhances,” said Dr JJ Chua, Consultant Plastic, Reconstructive and Cosmetic Surgeon, Mount Elizabeth Medical Centre.

“Cosmetic surgery is not for children and babies. No patient should subject their children to beautifying treatments till after puberty at least, if not, 21 years old, when they can make their own decisions legally.

“Reconstruction surgery can be further divided into the following sub-specialties: congenital, burns and trauma. Congenital conditions include any malformations including abnormal head shapes and proportions, cleft lip and palate, poorly developed ears, droopy upper eyelids and a variety of birthmarks. Plastic surgeons also treat children with acute burns and their scars after healing. Trauma may lead to facial cuts and facial bone fractures.”

Parental Concerns

As with any medical procedure your child has to go through, it’s normal for parents to have concerns. One real concern is that children are subjected to and react differently to medical treatments from adults.

For example, said Dr Chua, while most conditions can be treated with just local anaesthesia in adults, paediatric treatments normally need general anaesthesia or intravenous sedation to be administered by an anaesthetist.

Children also require constant care. On top of that, the surgeries may disrupt their usual routines. “Adults come and go by themselves, children need adult supervision and care,” explained Dr Chua.

“Adults know the importance of taking good care of the wounds, children may pull and yank at the wounds. Also, multiple treatments and surgeries are needed for cleft lip and palate. And birthmarks may need multiple repeated laser sessions, taking time away from school.”

And while parents will undoubtedly be nervous about the procedures as well as the after-care involved, it’s best to direct all your queries to your doctor, who will be able to address your concerns.

“The doctor will explain the condition, the prognosis, the various treatment options, the expected recovery and the potential risks to the parents,” said Dr Chua. “Realistic expectations are paramount.

“Psychological support is needed for the child too. Parents can’t become overprotective or overly concerned, or the child will grow up thinking that they are disabled or hideous. Allow normal activities like swimming, running or soccer. Instructions on post-care will be provided by the doctor too.”

Dr Vincent Yeow from Dream Plastic Surgery at The Paragon added: “All surgery results in scarring and the best timing for surgery is different for different pathologies. Most will not require long-term care unless growth and development plays a part in the disease.”

As with most medical procedures, there are some possible side effects with reconstructive surgery too. As Dr Chua explained, the most common ones are improvements not meeting expectations. For example, a cleft lip patient will never look or function exactly like normal. There is also a two per cent risk of infection, excessive bleeding or scarring.

girl with smile

How Much Does It Cost?

Costs for such procedures vary. Dr Chua offered a guide as well as an explanation of the procedures involved:

Cleft lip repair at three months old – around $15,000 for surgery, anaesthesia, medication, materials and consultations. The lip is closed so that there is no break in the upper lip. General anaesthesia is administered and a hospital stay for a few days is needed. The muscles and skin are repaired during the procedure and nose reshaping may be needed.

Cleft lip repair at nine months old – around $15,000, as above. Speech therapy will be needed later.

Abnormal head shapes may need a few different surgeries, so it’s hard to give a cost estimate. The scalp is cut open, the bones are separated by special saws and the bone pieces are replaced to create a nice normal shape. The bone fragments are held together with inert titanium plates and screws. Fusion will occur with healing and the bone becomes a solid skull. May also need reshaping, repositioning of orbits, eyes, nose, mouth etc.

Birthmark removal may need one or repeated treatments with either injections (around $200 each time), lasers (around $1,000) or surgery (wide range of costs). Birthmarks may be red, brown, black or hairy.

According to Dr Yeow, who is also the Chairman of Operation Smile Singapore, cleft lip and palate operations cost between $4,500 and $25,000; benign growth removal between $300 to $5,000; birthmarks removal between $300 to $4,500; and vascular lesions from $3,000 upwards.

Living Proof

Operation Smile Singapore is the local arm of the international children’s medical charity that “heals children’s smiles, forever changing their lives”. Medical professionals who volunteer with this organisation provide reconstructive surgery for children born with facial deformities such as cleft lip and cleft palate.

Since 1982, Operation Smile has provided more than 3.5 million comprehensive patient evaluations and over 200,000 free surgeries for children and young adults. It has a presence in over 60 countries and also helps maintain medical equipment, develop in-country foundations that manage their own resources and establish Care Centres that provide year-round surgical and related medical treatment.

Here are some of their success stories:
Molyny, Phnom Penh – the little girl was abandoned at a missionary centre by her family when she was just 29 days old. Although the nuns looked after her, the child’s cleft lip and cleft palate made feeding difficult, resulting in Molyny being underweight and susceptible to illness. The nuns brought her to an Operation Smile medical mission in the city when she was nine months old. Molyny had cleft lip surgery and soon gained weight and started to speak and was on her way to a better future.

Nhan, Hanoi – born with a torn disfigured lip, Nhan’s parents were worried that he would be an outcast in their village. The poor rice farmers travelled 250 miles to Hanoi and, to their relief, Nhan was among 127 children chosen by Operation Smile for surgery. At eight months old, his cleft lip was made whole and he now has a happy, radiant smile. His mother is also at peace knowing that he will have better opportunities for a bright future.

Hinabom, Deesa – Hinabom Turi travelled on foot with her mother and grandmother to Operation Smile’s medical mission site in the northern Indian city. The two-year-old was among the patients chosen to receive cleft lip surgery. After her 45-minute surgery, the girl and her family were full of smiles.

2014 Smile Asia Week - cake-2

Every three minutes, somewhere in the world, a child is born with a cleft lip or a cleft palate. Smile Asia Week happens 5-11 May this year and during this time the Ritz Carlton Millennia Singapore will be selling a limited-edition Valrhona Chocolate and Banana Cake to raise funds for Operation Smile –- a medical charity that helps facilitate operations for children who have cleft palates and cleft lips. Whether you need a cake for a celebration, Mother’s Day, or just because, why not order one of these by clicking on the link below? Each cake costs $33 and all proceeds go straight to Operation Smile.

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Smile, Baby, Smile: Reconstructive Surgery for Children