Melanie Cole (Host): If you're a parent whose child needs plastic surgery as a result of birth or trauma, thanks to new techniques and medical advancements, doctors can now successfully correct disfigurements and offer that child a chance to have a normal life. My guest today is Dr. Lee Alkureishi. He's a pediatric plastic and cranial facial surgeon with Shriners Hospitals for Children - Chicago. Dr. Alkureishi, what differentiates a pediatric plastic surgeon from an adult plastic surgeon? What's different in your training and your philosophy of care?

Dr. Lee Alkureishi, M.D. (Guest): That's a great question. So pediatric plastic surgeons are plastic surgeons first. We all go through the same residency training program and then pediatric plastic surgery is generally a one-year fellowship; an additional year of training after the end of residency. And during that year, we focus on- in addition to general plastic surgery principles, we focus on looking after patients with conditions that affect children; congenital conditions, birth defects, that sort of thing.

We use all the same techniques and principles that a general plastic surgeon does, but in addition to that, we have to take into consideration differences in the conditions and the patients in the growing child and have the ability to change as the child grows.

Melanie: What are some of the most common conditions requiring pediatric plastic surgery that you see?

Dr. Alkureishi: Cleft lip and palate is one of the most common conditions that we look after. That's patients who are born with a cleft of either the lip, the palate, or both, and those patients will generally require multiple surgeries through the course of their childhood to correct those birth defects.

Other conditions that are common or relatively common in the pediatric plastic surgery field are birthmarks, birth defect, nevi which are congenital moles, head shaped differently related to premature fusion of skull sutures. A little bit less common, but those are also a large part of our pediatric plastic surgery practice.

Melanie: And now many kids have birthmarks, they have nevi, they have- or even scars that they have. So speak about how plastic surgery and pediatric plastic surgery affects these children and changes their lives if they are someone who has a birthmark that's pretty visible or a scar revision. And do these things always have to be surgically removed as far as birthmarks? Tell us a little bit about that.

Dr. Alkureishi: Absolutely. So birthmarks and scars are different mechanisms, but the end result in terms of how the child feels about them may be very similar, especially when it involves a cosmetically sensitive area like the face. Any difference in facial appearance can be something that a child is very sensitive to, especially as they start getting into the school age years. And so there are many reasons why a scar or a birthmark may- we may choose to do a surgery for that, but one of the reasons may be to improve the appearance of either the birthmark or the scar.

Now certain types of birthmarks may need to be removed for other reasons, and it's always best if there's any question to see your physician and then your surgeon for advice on the indications for surgery; whether it's required, whether it's advised, and whether anything could be done to- aside from any medical issues, to improve the appearance.

Melanie: What else would you like to discuss as far as maybe there's jaw surgery, and where do you see children being mostly affected when it comes to pediatric plastics? Because you're changing their lives, Doctor. So it's something that makes them feel normal again, as I said in my intro, so what do you see as exciting that's going on in your field?

Dr. Alkureishi: One of the main reasons I started in this field was the opportunity to take patients with conditions that would be viewed as abnormal and bring them as close back to what would be considered normal as possible and to give them the best opportunity to live a normal life.

You mentioned jaw surgery. Jaw surgery is any surgery to move the position of the jaw and the teeth along with them, and the reasons that we would do that are when the teeth are in enough of an abnormal position that the orthodontist along with braces is just not able to get the teeth in a good position. And so in those cases we'll work very closely with the orthodontist and ultimately perform the surgery to move the jaw, which has multiple benefits in terms of allowing the orthodontist to get the teeth in the correct occlusion, and sort of come together and allow normal biting and chewing. But also it has the benefit of potentially improving the profile of the patient's face, improving their overall appearance, and so we'll work very closely with the orthodontist for those kids.

Now those kids may be kids who also have a cleft lip and palate or a cleft palate. We know that around 20% of those patients ultimately have abnormal growth of the upper jaw and will require jaw surgery later, but it can also be kids who just for whatever reason have an upper jaw or a lower jaw which grows more or less than the other jaw and their teeth end up in a position which just doesn't give them mobility to bite and chew correctly.

Melanie: So I think that's an important point, Dr. Alkureishi, is that not all- and parents might be confused about plastic surgery and craniofacial surgery where it applies to children. Not all of it is cosmetic, much of it is not, and some of it really affects the quality of life. As you wrap it up for us, and you just stated about biting and chewing, and cleft lip and palate, and things like birthmarks or scars; what would you like parents to take away from this segment as far as messaging about the importance of finding a good pediatric plastic surgeon for their child and how it really can change a child's life?

Dr. Alkureishi: Absolutely, and I think you touched on the main point there. As a resident in plastic surgery, a trainee in plastic surgery, we learn all of the techniques that are applicable to reconstructive surgery for any reason, as well as those techniques in cosmetic surgery or aesthetic surgery. And the techniques used in those two fields are very closely related.

When it comes to adult plastic surgery, there is a fairly important distinction between cosmetic surgery and a reconstructive surgery although the techniques may be very similar. When it comes to pediatric plastic surgery, there's very little in the pediatric plastic surgery world which would be considered a purely cosmetic procedure, although many of the surgeries that we do which are reconstructive in nature or constructive in nature have an aesthetic component to them because we're working in an aesthetically sensitive area like the face, the eyelids, or anywhere that's potentially a visible part of the body. And naturally as kids are going through their school age years, that becomes an increasingly important part of their self-image and self-esteem.

So one of the most rewarding aspects of pediatric plastic surgery for me is being able to give children the opportunity to lead a normal life and to not go through life concerned about having a difference, which other children may make note of and potentially tease. And so that's one of the best aspects of this field from my standpoint.

In terms of finding a pediatric plastic surgeon, as with finding any surgeon or any physician, it's always important to go to someone who's recognized by the national certification authority. So that would be someone who's board certified, and that way they've gone through a regular vetting to make sure that they are doing surgery and offering surgery which is appropriate and in the best interest of the child.

Melanie: It must be very rewarding for you, Dr. Alkureishi, and what a wonderful burgeoning field that you're in, and thank you for all the great work that you're doing at Shriners Hospitals for Children - Chicago. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children - Chicago. For more information, please visit www.ShrinersChicago.org. That's www.ShrinersChicago.org. This is Melanie Cole, thanks so much for listening.