Facial fractures are usually repaired once. If the bones are put back accurately and held while they heal, the result tends to look after itself. If they are not, correcting the position later means cutting healed bone again, and the second operation is always harder than the first. That is why the choice of surgeon matters more here than the short timeframe suggests. You still need to move quickly, because facial bones begin to unite within a couple of weeks, but you usually have a few days in which to choose sensibly.
What training should the surgeon have?
Facial fractures are managed by surgeons with formal higher training in facial trauma. In India that usually means a plastic and reconstructive surgeon holding M.Ch. in Plastic Surgery or DNB in Plastic Surgery, or an oral and maxillofacial surgeon with the equivalent recognised training. Either background can be entirely appropriate. Degrees alone do not settle the question, but they tell you where the surgeon started. What you are checking is that the training was formal, that it covered the whole facial skeleton and not only the teeth bearing bones, and that facial trauma is a regular part of the surgical work done there rather than something attempted occasionally.
How often do they operate on your kind of fracture?
The face is not one operation. Repairing a fractured eye socket floor, a cheekbone, a nasal complex, an upper jaw and a lower jaw are different problems with different approaches. Ask how frequently the surgeon treats the specific fracture you have. A surgeon who does eye socket reconstruction regularly will talk fluently about the risks to the eye, about implant choice and about how the position of the eyeball is judged during surgery. Someone who treats it rarely will keep the conversation general. That difference is easy to hear once you know to listen for it.
What should the consultation include?
A proper facial trauma consultation is quite systematic, and you can tell a lot from whether these things happen.
- A careful examination of your bite, with your own account of how it used to feel.
- Testing of eye movements and vision if the eye socket or cheekbone is involved, and a referral to an ophthalmologist if there is any doubt.
- Checking sensation over the cheek, upper lip, lower lip and chin.
- Feeling along the bony rims for steps, and measuring how far you can open your mouth.
- Review of a computed tomography scan with you, not just a verbal summary of it.
- A clear statement of which fractures need fixing, which do not, and why.
Being shown your own scan and having the fracture pointed out is a good sign. It usually means the surgeon has actually planned the approach.
What questions are worth asking?
- Which of my fractures actually need surgery, and what happens if we leave any of them?
- Where will the incisions be and will any of them be visible?
- What is the plan for my bite, and will elastics or wires be used?
- How often do you perform this particular repair?
- What are the specific risks in my case, including risks to the eye and to sensation?
- What will the recovery involve, and when could I return to my work?
Good answers are specific to your scan and your face. Answers that would fit any patient are less reassuring. It is also fair to ask who else will be in theatre and who will see you at the reviews afterwards, since continuity matters over the months of healing that follow a facial injury.
What does the hospital need to provide?
Facial trauma surgery needs a hospital with access to computed tomography imaging, an anaesthesia team comfortable with airway management around the face and jaws, the range of plates and screws that different facial bones require, and, where the eye socket is involved, the ability to obtain an ophthalmology opinion quickly. If your injury also involves the head, chest or limbs, you need a hospital where those teams work together. It is fair to ask whether the implants that might be needed will actually be available on the day.
What are the warning signs?
- Any promise that your face will look exactly as it did before, or that sensation will fully return.
- A plan made without a computed tomography scan when the injury clearly involves the mid face or eye socket.
- Reluctance to discuss complications, or annoyance at being asked about them.
- Pressure to book surgery immediately without explanation, in a situation that is not an emergency.
- No written estimate, or a figure that changes each time you ask.
- Marketing built on superlatives rather than qualifications, training and surgical experience.
None of this applies when the situation is genuinely urgent. If you have loss of vision, breathing difficulty, uncontrolled bleeding, clear fluid from the nose or reduced alertness, go to an emergency department now and let the treating team decide.
Is a second opinion reasonable?
Yes, provided you seek it quickly. Because facial bones start to set, a second opinion is useful in the first week and much less useful in the third. Take your scan images, not only the report, and take photographs of yourself from before the injury. A surgeon looking at the same scan may agree with the plan, which is worth knowing, or may suggest a different approach to the incision, the sequence of repair or whether a particular fracture needs fixing at all.
Where does Elegance Clinic fit in?
Dr. Ashutosh Shah is a Plastic, Reconstructive and Cosmetic Surgeon in Surat, Gujarat, with more than 22 years of surgical experience, an M.Ch. in Plastic Surgery from The Maharaja Sayajirao University of Baroda and DNB from the National Board of Examinations, New Delhi. He practises both reconstructive and cosmetic surgery, has trained more than 90 surgeons in hands on workshops and is the founder of Elegance Vidhyalaya. Written estimates are given before admission and enquiries go to WhatsApp. Whoever you choose, choose quickly, ask for the reasoning behind the plan, and make sure the person operating on your face does this work often.
