Cleft Lip & Palate

A cleft lip and/or palate (roof of mouth) occurs when the sides of the lip and/or palate do not come together during the formation of the baby’s head and neck early in pregnancy. This incomplete development usually leaves an opening in these areas.

A cleft can occur in about one in 600 newborn babies. Each cleft is unique in its appearance and severity. The cleft can affect the lip alone, palate alone, or both the lip and palate. The cleft can occur on one side (unilateral) or both sides (bilateral) of the lip and/or palate. A cleft in the palate can affect the soft palate alone, hard palate alone, or both the soft and hard palates. A cleft can affect the baby’s feeding, hearing, speech, and nose.

How long will the procedure take?

A cleft lip is usually repaired in the first months of your child's life. A cleft palate is usually repaired in the first year of life. Each procedure usually takes about one and a half to two hours.

Where will the incisions be?

The incisions of the lip repair are located on the upper lip and are hidden around the base of the nose. The incisions of the palate surgery will be along the roof of the mouth.

What will recovery be like?

Both types of surgical repair will require your child to stay at least one night in the hospital to be sure that they are able to eat and drink normally before going home. Dr. Aboutanos will be sure that you are comfortable with all instructions before you leave the hospital.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Craniosynostosis

Craniosynostosis is a condition caused by early closure of one or more of the normally present bone gaps between the bones of the skull. These gaps are called sutures. The cranial sutures allow the brain to grow and expand during the first year of life. Normally, these sutures close at different times in a patient’s life as brain growth stops. If a suture closes too early, the brain may not have adequate room to grow.

Approximately one infant in every 1,000 births will have early closure of a cranial suture. Craniosynostosis does not improve over time and it can worsen as the child grows. This may result in a ridge in the area of the closed suture and change in the shape of the skull. Some of the sutures that are affected are: metopic, coronal, sagittal, and lambdoid. If more than one cranial suture is fused or closed, the pressure inside the brain can become higher than normal. The diagnosis is confirmed by examination of the child and, in more complicated cases, with x-rays and/or a CT scan of the head.

How long will the procedure take?

Typically, craniosynostosis repair can take about four to five hours. The goal of the surgery is to open the closed sutures to prevent problems with high pressure in the brain and to allow the brain to grow normally. The second goal is to obtain a normal shape of the skull and face. The timing of your child's surgery depends on your child's condition and any associated medical problems.

Where will the incisions be?

The incisions are typically hidden in the hair at the top of the scalp. The incision is made in such a fashion as to blend with the hair and lessen the appearance of the scar, even when the hair is wet.

What will recovery be like?

The recovery typically involves one night in the Pediatric Intensive Care Unit (PICU) and then two to three nights on the Pediatric floor. This is to be sure that your child recovers safely before going home.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner. She will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Plagiocephaly and Helmet Therapy

Helmet therapy is a type of treatment for children who have been diagnosed with plagiocephaly. Plagiocephaly means an abnormal head shape that can be a result of positional molding or closure of one of the skull’s soft spots earlier than expected. If your child has plagiocephaly from positioning, helmet therapy may be used as a treatment to remold the head into a more normal head shape.

What causes positional molding?

Positional molding can occur as a result of your child sleeping on the back of his/her head, which is recommended by the American Academy of Pediatrics and the "Back To Sleep" campaign to prevent Sudden Infant Death Syndrome (SIDS). Positional molding can also occur because of tight neck muscles or torticollis.

What is helmet therapy?

Positional molding, if detected early enough, may improve on its own within the first six months of life with position changes alone. Dr. Aboutanos has seen improvement in patients with moderate to severe positional molding with helmet therapy. Helmet therapy is indicated for children under 14 to 18 months of age. The helmet is typically used 23 hours a day for an average of three months. Most children are able to get used to the helmet within the first few days of use.

How is the helmet made?

An orthotist company makes a helmet that is specifically designed to fit your child's head shape and size. Dr. Aboutanos and the orthotist will see your child frequently to track your child's progress and head growth.

What else should I know about this procedure?

Dr. Aboutanos is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner. There has been a variable response by insurance companies regarding helmet therapy. If you have questions about coverage for helmet therapy, please contact your insurance company directly. Dr. Aboutanos will assist you with this process.

Ear Pinning (Otoplasty)

Pediatric ear pinning, also known as otoplasty, is a procedure designed to improve the appearance of prominent ears in children—often as a way to combat or prevent teasing or bullying in school and help the child develop healthy self-esteem.

During surgery, Dr. Aboutanos adjusts skin and cartilage to form a smaller, more normal looking ear that sits close to the head.

How old does my child have to be to have ear surgery?

Typically, we recommend waiting until your child is at least 5 years old. This can be an ideal age, as they will be able understand a little bit more about what is happening to them—and we can help correct the appearance of their ears before they begin school.

That being said, Dr. Aboutanos has helped a large number of patients ranging in age to feel more comfortable and confident with the size and protrusion of their ears. The “right” time for the procedure can only be determined by you and your family.

We encourage you to read Dr. Aboutanos’ tips for preparing your child for pediatric plastic surgery to help make the process less scary for your little one.

How long will the procedure take?

Ear pinning typically takes around two hours. It is an outpatient procedure that is performed under general anesthesia, so your child will be able to return home the same day after a brief stint in the recovery room.

You will be able to visit with your child immediately before and after surgery, and we will make sure to keep you updated throughout the procedure.

Where will the incisions be?

While this can vary depending on how prominent or large your child’s ears are, Dr. Aboutanos is careful to place incisions along the back of the ear in natural folds. Once they are healed, the resulting scars will not be easily visible.

What will recovery be like?

For the first night after surgery, your child may seem a little “loopy” as the anesthesia wears off. They’ll likely be tired and disinterested in doing much. Soreness of the ear, especially around the incisions, is normal for the first few days, and we will prescribe pain medication as needed to keep them comfortable.

While your child will need to avoid any strenuous activity, sports, and rambunctious play, they should be up and around and starting to feel more normal relatively soon after surgery day.

Over the next two weeks or so, the incisions will continue to heal and any residual bruising and swelling will go down. The head wrap your child came home in will be removed in the office a day or two after surgery, and we will provide you with instructions on how to care for the incisions

Ear Piercing

Ear piercing is a simple procedure done in the office to let you wear your special earrings. Dr. Aboutanos can pierce your earlobes in a safe and efficient manner, without the risks associated with ear piercing guns or unsanitary piercing stalls at the mall.

Dr. Aboutanos can provide this service for babies, young children, and adults for the first time or after earlobe repair. Ear piercing services include a pair of earrings, one bottle of antiseptic solution, and instructions for after-care. To schedule a consultation for ear piercing with Dr. Aboutanos in Richmond, VA, please call 355-3410.

Hemangioma and Vascular Malformations

Hemangiomas are raised birthmarks, normally red, blue, or purple. Hemangiomas are clumps of blood vessels that did not grow normally and can appear in different shapes and sizes over any part of the body. It is important to distinguish a hemangioma from a vascular malformation as this will determine the type of treatment the child might require. Hemangiomas that affect vision, breathing, or feeding can be serious and may need additional treatment.

The majority of hemangiomas resolve on their own and do not require treatment. Half of all hemangiomas resolve by age five.

How long will the procedure take?

Surgery to remove a hemangioma or vascular malformation can depend on the size of the lesion and the location.

Where will the incisions be?

All incisions are made to allow complete removal of the hemangioma or vascular malformation in a safe manner while taking into consideration appearance and function.

What will recovery be like?

Recovery typically depends on the extent of the surgery. Dr. Aboutanos will guide you through this process.

What else should I know about this procedure?

The timing for surgical removal of hemangioma and/or vascular malformation can vary from child to child. Dr. Aboutanos can discuss the risks and benefits of the procedure and the best timing for this surgery.

Tissue Expansion

Tissue expansion is a process designed to recruit additional skin when extra skin is needed for reconstructive surgery. A tissue expander is like a balloon that is placed under the skin and, over time, filled with saline (salt water) until enough skin is stretched. Tissue expansion is a process that may be used in the treatment of congenital conditions, cancer, trauma, and breast surgery.

How long will the procedure take?

The time required for placement of a tissue expander is variable depending on the location and the condition being treated. After the expander is placed under the skin, it is filled with some fluid to start the expansion process. Over time, more fluid is filled until the desired amount of skin is stretched. Once all of the fluid has been placed, the expander is removed and the stretched skin is used in reconstruction of the adjacent condition in which it is needed.

Where will the incisions be?

The incisions are placed near the area to be reconstructed.

What will recovery be like?

Depending on the location affected, recovery can typically take one to two weeks.

What else should I know about this procedure?

After the initial surgery, the ongoing process of tissue expansion can be done in the office under local anesthesia for adult patients. This typically takes about 20 minutes. Children may need to have expansion done in the operating room with anesthesia. Dr. Aboutanos can help answer any questions about this process.

Syndactyly

Syndactyly is a congenital condition in which a child is born with a fused finger and/or toe. The appearance of the fused finger or toe is variable and can have soft tissue and bone present. Separation of the fused digit, also called syndactyly release, is a common procedure performed to create a normal webspace. This surgery is typically performed when the child is older than three months of age. Syndactyly release is often combined with a skin graft procedure to put skin along the inner aspect of the separated digits.

How long will the procedure take?

Syndactyly release is a procedure that is done in the operating room under general anesthesia. The procedure can take about one to two hours depending on the severity of the fusion and if there is bony involvement.

Where will the incisions be?

The incisions are typically along the inside of the two fused digits. There will be a separate incision for the skin graft if it is used. All of these incisions usually go on to heal nicely over time.

What will recovery be like?

Recovery from syndactyly release is typically one to two weeks. In older children, it is important to avoid weight bearing on the affected extremity to prevent injury to the area after surgery. Dr. Aboutanos will discuss any limitations in activity or sports after this procedure.

What else should I know about this procedure?

Dr. Aboutanos will examine your child to determine the best timing for surgery and the need for additional studies before surgery. In some cases, an x-ray of the child's hand or foot in preparation for surgery may be helpful. Dr. Aboutanos will review the results with you and answer all questions regarding your child's care.

Polydactyly

Polydactyly is a congenital condition in which a child is born with an extra finger and/or toe. The appearance of the extra finger or toe is variable and can have soft tissue and bone present. Removal of the accessory (extra) digit is common and is typically done when the child is older than three months of age.

How long will the procedure take?

The procedure is performed in the operating room under general anesthesia. It typically takes about 1 hour to perform.

Where will the incisions be?

The incisions are made at the base of the accessory finger or toe so that it blends with the side of the hand or foot. As the child grows, there should be no functional deficit associated with the scar.

What will recovery be like?

Recovery from removal of an accessory finger or toe is typically one to two weeks. In older children, it is important to avoid weight bearing on the affected extremity to prevent injury to the area after surgery. Dr. Aboutanos will discuss any limitations in activity or sports after this procedure.

What else should I know about this procedure?

Dr. Aboutanos will examine your child to determine the best timing for surgery and the need for additional studies before surgery. In some cases, an x-ray of the child's hand or foot in preparation for surgery may be helpful. Dr. Aboutanos will review the results with you and answer all questions regarding your child's care.

Amniotic Band Syndrome Treatment

Trust your child’s health and well-being to a skilled, caring pediatric plastic surgeon

Having your child diagnosed with amniotic band syndrome can be an overwhelming experience, leaving you feeling scared and unsure what to do. That’s where Dr. Sharline Aboutanos comes in. Her friendly bedside manner, commitment to patient comfort and safety, and vast knowledge of pediatric plastic surgery make her an excellent choice for treating the conditions associated with your child’s amniotic band syndrome.

What is Amniotic Band Syndrome?

Amniotic band syndrome occurs when fibrous bands wrap around parts of the fetus in the womb. These bands can affect the way a baby develops and grows. They can restrict circulation to the baby’s extremities, often resulting in partial or complete amputation of the baby’s fingers, toes, hands or feet. Conditions associated with amniotic band syndrome include webbed fingers (syndactyly), nail deformities, arms or legs of different lengths, lymphedema of the legs or arms affected, and band indentations. Other conditions associated with amniotic band syndrome include hemangioma, cleft lip and/or palate and clubfeet. Each child affected by amniotic bands can have different clinical symptoms.

Amniotic band syndrome is rare. It is not a genetic or inherited condition. It is thought to be caused by damage to the amniotic sac. Amniotic band syndrome can be diagnosed by ultrasound in utero. X-rays of the baby’s hand or feet may be necessary after birth.

How Do You Treat Amniotic Band Syndrome?

Treatment options vary for each child and depend on the severity of the banding. Reconstructive surgeries include cleft lip and palate repair, syndactyly release (separating fingers) with and without skin grafting, and release of constricting bands. Timing of surgery depends on the severity of the bands. Cleft lip repair typically occurs at three months of age. Syndactyly release and release of constricting bands typically begins at six months of age. Cleft palate repair is performed before one year of age.

There is no increased risk of amniotic band syndrome in future pregnancies. Other names for amniotic band syndrome include amniotic constriction bands, constriction band syndrome, congenital constriction rings, Streeter anomaly and Streeter bands.

Dr. Aboutanos is a pediatric and craniofacial plastic surgeon in Richmond, Virginia who can care for your child with amniotic band syndrome as he/she grows and develops. Dr. Aboutanos is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she can coordinate your child’s reconstructive needs with other specialists, such as speech and physical therapists. She will help guide you through each surgery and phase of growth with kindness, understanding, and an expert touch.

Apert Syndrome

Apert syndrome is a genetic disorder which affects the child’s skull, face, hands, and feet. This syndrome will affect the skull by fusion of both coronal sutures (craniosynostosis), causing an abnormal head shape and possibly an increase in the pressure on the brain. These skull changes lead to changes in the face. Primarily, we see underdevelopment of the upper and middle part of the face (midface hypoplasia). Facial features include widely spaced eyes, bulging of the eyes, an underdeveloped and ‘sunken-in’ appearance of the mid-face, and/or narrow roof of the mouth. This condition may also involve complex webbing (syndactyly) of the hands and feet.

What causes Apert syndrome?

Apert syndrome is a very rare genetic disorder. The incidence of children born with this disease can be 1 in 65,000 to 1 in 160,000. It can be passed on from the child’s parents through autosomal dominant inheritance, meaning that only one parent needs to have the abnormal gene for the child to inherit the disease. The majority of cases are not inherited; in these cases, there was a new mutation in the child’s fibroblast growth factor receptor 2 gene, located on chromosome 10.

What is treatment like for Apert syndrome?

Apert syndrome is a complex condition that requires multiple stages of treatment over the course of the patient’s lifetime. Craniosynostosis is treated by performing surgery to the skull. Oftentimes, the upper and middle face will require surgery as well. The first goal is to open the closed sutures to prevent problems with high pressure in the brain and allow the brain to grow normally. The second goal is to obtain a normal shape of the skull and face. The timing and type of surgery your child will have depends on your child’s condition and your surgeon. Your surgeon will also discuss the timing of hand and feet syndactyly release.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists.

Crouzon Syndrome

Crouzon syndrome is a genetic disorder which affects the child’s skull and face. This condition occurs when there is abnormal fusion between some of the bones of the skull and the bones of the face, therefore preventing normal growth. Such growth affects the shape of the head, the appearance of the face, and the relationship of the teeth.

What causes Crouzon syndrome?

Crouzon syndrome is a very rare genetic disorder. It can be passed on from the child’s parents through autosomal dominant inheritance. This means that only one parent needs to have the abnormal gene for the child to inherit the disease.


The majority of cases are not inherited, which means that there was a new mutation in the child’s fibroblast growth factor receptor genes located on chromosome 10 or chromosome 4.

How is Crouzon syndrome treated?

Crouzon syndrome is a complex condition that requires multiple stages of treatment over the course of the patient’s lifetime. Surgery is required to correct craniosynostosis, in which the seams of the skull fuse too early and obstruct normal brain development. To treat this, surgery is performed to open the seams of the skull (also called sutures); oftentimes, the upper and middle face will also require surgery. The first goal of surgery is to open the closed sutures to prevent problems with high pressure in the brain and allow the brain to grow normally, and the second goal is to obtain a normal shape of the skull and face. The timing and type of surgery your child will have depends on your child’s condition and your surgeon.

What else should I know about Crouzon syndrome treatment?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Treacher Collins Syndrome

Treacher Collins syndrome is a rare genetic disorder that leads to the underdevelopment of the bones and other tissues of the face. There can be a wide range of signs and physical characteristics of this disorder, from almost unnoticeable to severe. Craniofacial abnormalities typically involve the cheek bones, mouth, jaw, chin, ears and/or eyes. Individuals with Treacher Collins syndrome often have downward slanting eyes, few eyelashes, and a notch in the lower eyelids called a coloboma. Affected individuals will also have underdeveloped zygomas (cheekbones) and small lower jaws. In addition, this condition may lead to hearing loss or cleft palate. In severe cases, underdevelopment of the facial bones may restrict an affected infant’s airway, causing potentially life-threatening respiratory problems.

What causes Treacher Collins syndrome?

Treacher Collins syndrome is an autosomal dominant disorder, which means that only one parent needs to have the abnormal gene for the child to inherit the disease. Some of the cases are not inherited, which means that there was a new mutation in the child’s genome.

How is Treacher Collins syndrome treated?

Treacher Collins syndrome is a complex condition that requires multiple stages of treatment over the course of the patient’s lifetime. Cleft palate repair is typically done after 6 months of age, but the timing depends on the child’s breathing status. It is also important to diagnose hearing problems early; our speech language pathologist and ENT surgeons will evaluate the child to determine the need for a bone anchored hearing aid (BAHA). The child may also need surgeries to fix the bones of the middle of the face, the ears, and the jaws. The timing of these surgeries will depend on your surgeons. Because the soft tissue of the face is underdeveloped, some children may benefit from fat grafting to improve their facial contour.

What else should I know about treatment?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Craniofacial (Hemifacial) Microsomia

Also known as first and second brachial arch syndrome, oral-mandibular-auricular syndrome, lateral facial dysplasia, or otomandibular dysostosis, craniofacial microsomia is a congenital condition in which the lower half of the face does not develop or grow normally. This condition can affect one or both sides of the face and may have various levels of severity, but usually always includes the abnormal development of the ear, the lower jaw (mandible), and mouth. After cleft lip/palate, this is the second most common facial birth defect.

What causes craniofacial microsomia?

The cause of craniofacial microsomia is unknown. It is a condition that begins during embryonic development.

How do you treat craniofacial microsomia?

Craniofacial microsomia is a complex condition that requires multiple stages of treatment over the course of the patient’s lifetime. Sometimes, surgical treatment to restore the child’s jaw position begins during late childhood or early adolescence. This will depend on the severity of the child’s condition, your dental team, and your surgeon. Surgical treatment by using a rib graft or mandibular distraction may be performed in certain cases. Children with both sides of their face and ears affected will have difficulty hearing and may benefit from a bone anchored hearing aid (BAHA). Our speech language therapist and ENT surgeon can help evaluate your child’s need for this device and any other speech concerns.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Pierre Robin Sequence

Pierre Robin sequence (PRS) is a disorder in which a baby is born with a small lower jaw (mandible), causing the tongue to fall back into the mouth and block the airway, which may lead to difficulty breathing. This condition can also cause the baby to have a cleft palate (open roof of mouth). The child will present with a very small or receding chin and the tongue will appear large. The cleft in the palate will have a U-shape, which is more typical of clefts formed due to Pierre Robin sequence.

What causes Pierre Robin sequence?

Pierre Robin sequence happens during a series of events during the child’s development as an embryo (that is why it is called a sequence). The cause of these events is unknown.

What is treatment like for Pierre Robin sequence?

The most important goal in treatment of Pierre Robin sequence is making sure the child is able to breathe adequately. This can be achieved by changing the baby’s position, placement of nasal trumpets (tubes that keep the airway open), tongue-lip adhesion surgery, mandibular distraction, or tracheostomy.


It will also be important to make sure the child is able to feed without difficulty. Our speech pathologist and feeding specialist will help your child every step of the way during this process.


The cleft palate is usually surgically repaired around 12 months of age. The timing of this surgery will depend on the child’s breathing and your surgeon. Your child may also need ear tubes placed, which will be determined by your child’s ENT surgeon. Your child will be followed by all the members of our dental team over the course of your child’s life.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as they grow and develop. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.

Velopharyngeal Insufficiency

Velopharyngeal insufficiency (VPI) occurs when air and sound escape from the child’s nose during speech, producing speech that sounds nasal in quality. VPI may lead to hoarseness or fatigue of your child’s voice.

What causes velopharyngeal insufficiency?

Normal speech is produced when the soft palate closes off the nasal cavity, allowing the air to escape through the mouth. Velopharyngeal insufficiency is caused when the soft palate cannot block off the nasal cavity, letting the air go out through the nose.

How is velopharyngeal insufficiency treated?

The first step in diagnosing and treating velopharyngeal insufficiency is making sure that your child has normal hearing and no signs of an ear infection. The next step is taking your child to a speech therapist who can listen to your child’s voice. Sometimes, speech therapy alone can improve your child’s speech disorder. In cases of severe speech disorders, surgery may be required.


The timing and type of surgery depends on your child’s condition and on the plastic surgeon. Further speech therapy may be required after surgery.

What else should I know about this procedure?

As a cleft and craniofacial specialist, Dr. Aboutanos is qualified and ready to care for your child as your child grows and develops. She is a member of the accredited Cleft and Craniofacial Team at St. Mary’s Hospital, and she will help coordinate your child's care with other specialists in a multi-disciplinary manner.