Plastic surgery to restore facial defects helps give mentally disabled children a better lease on life

Reconstructing severe facial deformities in children with mental disabilities can be a hard decision for parents. Insurance companies may consider some operations to be only for cosmetic purposes and refuse to cover them.

However, craniofacial plastic surgery, to correct abnormalities of the face, skull and neck, may give these children significant psychological, social and emotional benefits that can help them attain a better quality of life, according to a report in the August issue of Plastic and Reconstructive Surgery, the official medical journal of the American Society of Plastic Surgeons (ASPS).

"Plastic surgery to correct defects of the face, skull, and neck is reconstructive and functional in nature, not merely cosmetic, as some insurance companies assert," said Steven Buchman, MD, ASPS Member Surgeon and author of the report. "Children with severe mental impairments undoubtedly benefit from plastic surgery and ultimately gain the functional tools that will help them lead a fuller life."

According to the report, a person's physical appearance can positively or negatively influence their ability to socialize. This, in turn, can influence long-term relationships with peers and employers as well as the ability to manage daily tasks and properly function in society. Because social relationships are key predictors of quality of life, children with facial deformities greatly benefit from craniofacial plastic surgery, allowing them to appear more normal and to help gain social acceptance.

People may use a person's facial characteristics to form opinions about traits and other personal attributes, according to the report. In the case of a child with mental disabilities and facial abnormalities, other children may react negatively and refuse to play with him or her, often causing the child to withdraw socially. Consistent rejection could lead to serious social impairments and impede the child's ability to relate.

In addition, the more these children are accepted by their peers, teachers and parents, and the more interactions they have with others, the better they learn. Teachers may underestimate the intellectual abilities of children with facial deformities and have correspondingly low expectations for their achievement. Parents may also unknowingly share these low expectations. By addressing the deformities, the subconscious bias of teachers, parents and other adults may diminish, giving the child a better chance to be exposed to positive feedback and increase their learning capability.

"Calling these surgeries cosmetic demeans the benefits these children gain," said Dr. Buchman. "By fixing their deformities, we positively change the way others interact, react and relate with them, helping shape how well they learn, socialize and adapt to the world around them."

Increasing insurance company denials, restrictions on covered procedures and a new tactic of excluding specific reconstructive procedures may be forcing some children and adults to live with disfigurement or painful medical conditions. This restrictive access to care contributed to a 10 percent decline in reconstructive plastic surgery procedures in 2004, the ASPS reports.