Facial bones are also made with a 3D printer… The world of cutting-edge facial reconstruction surgery[건강 기상청 : 증상으로 본 질병]

2024-05-02 22:08:59

[인터뷰] Park Ho-jin, Professor of Plastic Surgery, Korea University Anam Hospital
Designed and produced on a computer… Patient-tailored 3D artificial bone transplantation
No foreign body sensation, no discomfort, ↑ satisfaction… Various accident insurance applicable

Park Ho-jin, professor of plastic surgery at Korea University Anam Hospital. Photo by reporter Ji Ho-young

‘Shineonseopan(身言書判)’. It refers to appearance, speaking skills, writing skills, and judgment, and refers to the four criteria used to evaluate people since ancient times. Among them, the most important thing was facial features, or appearance. The face is responsible for not only the physiological activities of seeing, hearing, breathing, and eating, but also social and psychological functions, such as expressing emotions and feelings such as sadness, joy, and surprise through facial expressions. These days, as appearance supremacy is intensifying, appearance itself is becoming a standard for defining one’s external characteristics. The face has now become a core tissue of the human body that dominates a person’s entire daily life.

But what if a part of the face is missing from birth or a specific part is damaged due to external factors such as an accident or surgery? In the past, you had to accept this as a death sentence and just live with patience, but these days, with the development of facial reconstruction using cutting-edge technology, most facial defects (tissues) can be created new or restored to their original state. What is facial reconstruction surgery and how far have the latest surgical techniques developed? To answer questions about this, I met Park Ho-jin, a professor of plastic surgery at Korea University Anam Hospital, who specializes in cutting-edge facial reconstruction surgery.

Revive lost facial areas!

What is facial reconstruction surgery?


“This is a surgery performed when there is a facial defect. In this case, defect refers to the absence of a specific part of the face. It can occur for a variety of reasons, including genetic abnormalities that occur at birth, accidents, surgery, and infections. “Defects can mainly appear in various parts of the face, including skin, muscles, bones, eyes, nose, and mouth.”

What is the difference between facial reconstruction and facial plastic surgery?

“Facial reconstruction surgery for cosmetic purposes is usually referred to as ‘plastic surgery.’ These include facial contouring surgery, double jaw surgery, and single jaw surgery. Plastic surgery focuses on improving or perfecting normal shape or structure. On the other hand, the goal of facial reconstruction surgery for therapeutic purposes is to restore defective or damaged areas to their original appearance.”

What are the criteria for selecting a surgical method for facial reconstruction?

“Depending on the characteristics of the defective tissue such as skin, bone, and muscle, the surgical method may vary depending on the defect area, such as the eyes, nose, ears, and mouth. Depending on the characteristics of each area, there are cases where skin defects need to be emphasized, and in other cases, bone defects are given priority. If the skin is damaged, skin grafting or skin flap surgery (surgery that covers skin from another part of the body) can be used, and if bone damage has occurred, bone grafting or bone flap surgery can be used. In this way, facial reconstruction surgery is performed according to the patient’s individual situation and characteristics of the damage, and therefore requires detailed evaluation and planning. “Often, a variety of methods are applied in combination.”

What types of facial skin reconstruction are there?

“First, there is skin grafting. This is a surgery in which the patient’s skin is harvested from areas such as the thigh, groin, and collarbone and placed on the defective area. Because it is a surgery that simply applies skin, it is difficult to use in cases where the defect is deep or the bone is exposed. When the tissue to be transplanted needs to be thicker, flap surgery is used rather than skin grafting. It is a surgery that brings the skin, fat layer, and muscle layer into one lump. “The flap surgery takes a long time because the amount of tissue to be transplanted is large and blood vessels must be connected under a microscope.”

What are the types of facial bone reconstruction surgery?

“Representative facial bone reconstruction techniques include grafting and flap surgery. Bone grafting is a surgery in which pelvic and skull bones are harvested and inserted into facial defects. Because it is a surgery that simply adds bone tissue, it is difficult to transplant a large amount of bone, and it has the disadvantage of leaving bone defects in the area where the bone was harvested. Bone flap surgery can be used when there is a large defect that is strong enough to withstand the force of chewing, such as the jawbone. “This is a surgery where the fibula of the calf is brought together with blood vessels and connected under a microscope.”

Customized artificial bone transplantation using a 3D printer

What is artificial bone grafting?

“Artificial bone was developed as a replacement for existing bone grafting. This is a surgical method that implants bone substitute material into the defective area to induce the formation of new bone or replace the bone itself. Previously, the method was to simply shape the bone with artificial bone paste or fold artificial bone material in the form of a square sheet and fill the defect. Recently, with the development of computer-assisted design and manufacturing (CAD/CAM) technology, it has become possible to identify the defect area for each patient in advance and produce artificial bones accordingly. “The artificial bone created in this way is called ‘patient-customized 3D artificial bone.’”

Do you mean implanting 3D artificial bones into patients?

“Patient-specific 3D artificial bone transplantation has recently been attracting attention as the most innovative approach in the field of facial reconstruction. This is a surgery in which the entire structure and shape of the patient’s face is analyzed using a computer program by comparing it to the defect area, the defect area is designed to resemble the shape before the damage, and an artificial bone is created and implanted using a 3D printer. In particular, the facial bones have a complex three-dimensional shape, which is a great help in restoring the shape of the face before damage.”

What are the advantages of patient-specific 3D artificial bone grafting?

“Using 3D printing technology, we can produce artificial bones that perfectly match the patient’s facial structure to achieve more natural results. In addition, compared to existing surgical methods, precise reconstruction is possible, which can further improve the patient’s facial function and appearance. “Using custom-made artificial bones reduces the need to adjust or reconstruct the bone during surgery, which may shorten surgery time.”

What is the satisfaction level of patients who actually underwent surgery?

“Satisfaction is very high because the face becomes completely symmetrical after surgery.”

Does it feel different or safer than existing bone?

“Because the bone has been restored deep into the skin, the actual feeling when touched is almost the same as the basic bone. There is almost no foreign body sensation or discomfort. “There is no need to worry about safety because it was made with a 3D printer using materials that have been used for decades.”

Is it the same principle as the commonly known engineering 3D printer?

“The principle of 3D design and manufacturing is the same, only artificial bone is used instead of engineering material.”

What is the material of artificial bone?

“We are printing by selecting various materials depending on the needs of each area. From a material that is biocompatible and flexible, but weak in strength and used in small defect areas (PCL), to a material that has low biocompatibility but is very hard and is used in large defect areas (PEEK), there are materials suitable for the defect area and patient’s situation. “I use ingredients.”

The future of artificial bone transplants containing osteocytes

Making artificial facial bones using a 3D printer. Photo provided by Professor Hojin Park

What is the process of making artificial bones?

“When a CT scan is taken of the facial defect area, a computer programmer reflects the plastic surgeon’s requirements based on the data, compares the defect area with the other side of the face, and then designs implant pieces symmetrically. If you put it in a 3D printer and print it, an artificial bone is created, and a transplant surgery is performed with this. “Currently, in the field of biomedical engineering, we are researching how artificial intelligence (AI) can replace the design of artificial bones, which must be done manually by programmers and doctors.”

What is the cost of patient-specific 3D artificial bone grafting?

“The results of the surgery are good and the level of satisfaction is high, but the biggest obstacle and concern is the cost. Although it is not for cosmetic purposes, this surgery is not yet covered by health insurance. However, among patients who have undergone reconstructive surgery due to facial defects caused by disease treatment or external factors, many patients receive benefits through various accident (life) insurance policies such as private actual loss insurance, automobile insurance, industrial accident insurance, and fire insurance. We recommend that patients with such insurance consider customized 3D artificial bone grafting.”

What is the future of patient-tailored artificial bone facial reconstruction?

“Currently, facial artificial bone transplantation is based solely on artificial bone that does not contain cells, but as technology develops in the future, artificial bone transplantation that includes bone cells will become possible. Artificial bones containing osteocytes will have a structure more similar to real human bones. “The innovative structure containing cells is expected to improve the perfection of reconstructive surgery because it is very similar to human tissue.”

Reporter Choi Young-cheol [email protected]

2024-05-02 22:08:59