Facial Geometry: A New Technique Realigns Boy’s Face

by Alexandra Kilpatrick

What facial features cause people to deem it as normal or deformed? Psychologists have determined precise mathematical ratios between eyes, nose and cheeks seen by others as acceptable.

Richard Hopper, head of the craniofacial surgery center at Seattle Children's Hospital, explains the phenomenon.

"If I'm talking to you, I'll just sort of naturally figure out if the balance of your face makes sense to me as a human being," Hopper told the Los Angeles Times. "If the balance is off, if your eyes are too far apart, if the ratios are wrong, it'll just keep nagging at you. A human mind can't get over it."

Studies have shown facial ratios can affect everything from who gets a job to which kids make friends easily in preschool to which kid develop good self-esteem.

"If you get a child and you show them a picture of their hand, they'll say, 'That's a hand.'" Hopper told the Times. "If you show them a picture of a foot, they'll say, 'That's a foot.' But if you show them a picture of their face, they'll say, 'That's me.'"

James's Remarkable Surgery

Hopper specifically worked with James Weathermax, an 11-year-old Alaska boy suffering from Apert syndrome, a rare genetic mutation that prematurely fuses bones within the skull, as well as fingers and toes, causing the top of the boy's head to balloon.

Until recently, surgical techniques for Apert facial deformities focused on the essentials like opening up breathing passages and making room for the brain to develop, while leaving the front of the face compressed and concave.

However, Hopper and his craniofacial surgery team have determined a way to fix Apert facial appearances as well. Hopper managed to realign the front of Weatherwax's face with a brand new technique called "Lefort II midface distraction and simultaneous zygomatic repositioning."

This quite intricate, daylong procedure involved cutting the entire front of the face off, rechiseling it and putting it back in place.

"The face is peeled forward and his scalp is brought down over his face to his chin," Hopper told the Times. "That gives us access to the eyeball area, the cheekbones, the forehead, the upper part of the eye sockets. The bone is completely removed and on a side table, like a carpentry shop, we use saws and chisels and plates and screws and re-create the eye sockets and the lower forehead in a new shape."

The triangular section of the reconfigured bone is then reattached to the skull, further forward. New bone eventually begins to grow, at a rate of a millimeter or two per day, on the side of the skull to make the face's new dimensions permanent.

While the main reason for these surgeries is to open up airways, the cosmetic benefits are also significant.

"We take that for granted, somebody saying, 'You look great today,'" Hopper said. "An Apert patient doesn't get that. I'm hoping that James has that experience."

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