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Faculty Focus

Mitchell Stotland, M.D.: Making faces

By Laura Stephenson Carter

In an office filled with childsize acrylic skulls, Dr. Mitchell Stotland peers at photos of an Iraqi boy whose face has been badly burned. DHMC's executive medical director has asked if Stotland, a craniofacial surgeon, and a couple of colleagues think they can help the child.

Stotland knows at a glance that he can reconstruct the boy's face. Although DHMC doesn't typically treat burn victims, "the management of chronic burn deformities is no different than other complex plastic surgical deformities," explains Stotland. "Whether it's a burn scar, or it's a surgical scar, or it's a motor vehicle accident scar, or it's some kind of birth mark—they're all the same approach to managing soft-tissue reconstructions."

The director of the Craniofacial Anomalies Clinic at the Children's Hospital at Dartmouth and of a program called Face of a Child, Stotland usually treats patients who live in the United States. But this wouldn't be the first time he'd performed surgery on a foreign patient. He recently did reconstructive surgery on a 16-year-old boy from China who was born with a giant black birthmark that covered half his face like a thick mask. Chinese surgeons had removed most of the pigmented mark and replaced it with skin grafts taken fromhis torso. But the transplanted skin had become taut, unnatural looking, and "gnarly," Stotland says. "Grafts never look perfect. They don't blush, they don't sweat, they don't have the same kind of oil, they look discolored, and they don't move as well" as non-grafted skin.

It took several months, but Stotland was able to grow new skin to replace the boy's skin grafts. He inserted tiny silicone balloons under nearby face and neck skin and gradually inflated them over time with injections of saline solution. As the balloons expanded, new skin cells began to grow and the tissue swelled into huge, blister-like bubbles. When the skin had stretched enough, the expanders were

Craniofacial surgeon Mitch Stotland uses delicate screws and wires to totally reconstruct deformed or injured skulls. His interest in the field was sparked by the TV show Nova.

removed and the new skin was repositioned to cover the affected area. The boy may still need several more procedures to look completely normal, but he's now well on his way.

Stotland's expertise in rebuilding faces extends beyond tissue repair. He corrects all sorts of facial deformities, from cleft lips and palates to malformed or missing ears to more severe deformities, where entire skulls have to be rebuilt. In addition to craniofacial surgery on children, he also does reconstructive surgery on adults—fixing both congenital deformities and accidental trauma. And he does Botox injections, nose jobs, and other kinds of cosmetic surgery, too.

Stotland was 18 years old when his interest in craniofacial surgery was sparked by an episode of the public television program Nova. The subject of the show was Dr. Paul Tessier, a pioneering craniofacial surgeon who in the 1960s and 1970s developed numerous craniofacial surgery techniques—virtually all of which are still in use today. Tessier

believed and proved that deformities of the skull and face could be corrected with radical and aggressive treatment.

"When I saw that [program], I thought that was a combination of so many things that appealed to me—being able to work with kids, to do something meaningful," says Stotland. "I always really had a soft spot for kids who just were shunned for no good reason other than their appearance. I can think of several kids growing up in school who were like that, who were probably every bit as intelligent and talented, but looked a little different."

As an undergraduate at McGill, Stotland would go to the library and read up on craniofacial surgery. So by the time he got to medical school, he already knew the names of famous craniofacial surgeons and was sure he wanted to do such work himself. Part of his training included a year-long craniofacial surgery fellowship with one of Tessier's disciples—Dr. Henry Kawamoto at the University of California at Los Angeles. Right after completing the fellowship, in 1997, Stotland joined the faculty at DMS, where another plastic surgery pioneer, Dr. Radford Tanzer, had developed the standard technique for ear reconstruction.

Stotland felt confident in his abilities by then, but he had a hard time believing that parents would actually entrust their children to him. He would be taking skulls off, moving eye sockets, and doing risky procedures that might cause a child to bleed to death. "I think I looked pretty young 12 years ago, and I felt young," he admits. "I remember thinking that 'I can't believe they're agreeing.'"

In 1998, he was thrilled to meet Tessier himself—at the inaugural lecture for a biannual program at UCLA honoring Kawamoto. He had a question for the legendary surgeon: "When you were doing this 25 years ago, and no one had done it before you, how did you get parents to accept what you were doing?" Tessier's answer, Stotland recalls, went something

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Laura Carter is Dartmouth Medicine magazine's associate editor.

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