Pediatric Plastic Surgeons Reshape Lives

When you think of plastic surgery, nips and tucks to hide the sags and wrinkles of aging faces may be the first thought that comes to mind. However, in pediatric plastic surgery, the focus is on helping young people face the future confidently so they can live their lives feeling more comfortable in their skin.

“Much of our work involves correcting problems a baby may be born with, such as cleft lip or cleft palate. There are also conditions such as craniosynostosis that become apparent and need treatment as a child grows,” Peter D. Ray, MD said. “Trauma and burns also bring young patients to us for help.”

According to Ray, pediatric plastic surgery is not so much a specialty as it is a calling. Beyond the years studying to become a physician, and advanced training developing the skills of a plastic surgeon, becoming adept in this highly specialized field requires additional time learning the nuances of care specific to growing children. Pediatric plastic surgeons are so rare, in fact, that Ray and his Children’s Hospital colleague John Grant, MD, are the only two surgeons practicing this specialty in the Birmingham area and they care for patients referred to them from across the region.

“Working with children is different, the instruments are different, and how they respond to medications is different,” Ray said. “In plastic surgery cases, you have to plan corrective surgeries considering not only how children will look now, but also how their features will change as they grow into adulthood.”

Ray also emphasizes the value of having the support of care teams at Children’s Hospital who are experienced in working with young patients.

“We have a pediatric anesthesiologist and a pediatric ICU where everything is geared to children,” Ray said. “We also work closely with physicians in many different specialties. For example, if we have a patient with craniosynostosis, a neurosurgeon may begin the procedure and I’ll step in to reshape the skull. In a trauma, I may work side by side with an orthopaedic surgeon, or in the burn unit. There’s a lot of collaboration. Some patients have complex disorders that require an entire team of specialists to coordinate their care.”

Ray says the first priorities are preserving life and function. Restoring appearance to help children look as normal as possible is the next step.

“At first, younger children are usually just curious if someone is different. As they get older, they start comparing themselves to each other. Gradually a pecking order develops, and looking different can have a negative effect on a child’s self-image that can affect him long term if it isn’t corrected,” Ray said.

“The functional surgeries may involve freeing a stricture or a burned finger so it can be used more normally. Sometimes we redo surgeries to reduce scarring on the face or anywhere on the body. Some corrections have to be done with a series of procedures as children grow,” Ray said.

For Ray, the road to becoming a pediatric plastic surgeon began in Bosnia and Afghanistan, where he commanded a forward surgical team.

“When we weren’t dealing with war injuries, we helped out locally in areas where there weren’t robust hospitals. We didn’t want to disrupt local medicine, but to support them. As a combat surgeon, you work in all kinds of conditions and learn techniques to deal with just about anything from head to toe. You learn to figure out what is needed and how to be creative in filling the gap.

“In Afghanistan, there were cultural things like cooking with open fires that brought us a lot of children with serious burns. Working with those kids, I realized that was what I was in this world for. That’s when I decided to be a pediatric plastic surgeon.”

Ray was interviewed on the 4th of July, a weekend he spends on call every year at Children’s Hospital to be ready for holiday related traumas that might come in.

“We aren’t seeing as many fireworks injuries as in the past—whether people are being more careful or the economy is having an effect, I’m not sure.” Ray said. “There are fewer scalding burns now that water heater temperatures are lower. Child safety seats are also having a positive effect on traffic traumas. One of the worst things we see is injuries from traffic accidents where children weren’t properly restrained.”

Ray says one serious problem that needs more awareness is lawn mower injuries.

“People don’t realize just how dangerous it can be to have kids near a mower. Less than two seconds, and you can have a serious trauma that may be hard or impossible to undo. We see too many terrible injuries from children falling off lawn mowers when they had been riding with a parent. They can fall in front of a mower, or even standing some distance away, they can be hit in the eye with flying debris. Children and mowers don’t mix.”

Ray says it’s also important to think like a kid when child-proofing a home, especially when children are at that dangerous climbing age.

“Kids like to climb. They can so easily tip over a TV, or pull a heavy bookcase or wardrobe over that can cause a crushing injury.”

When children are sick or injured, it can be tough to be the adult in the room. “Sometimes it seems harder on parents and caregivers. Kids are inspiring and resilient. Kids power through.” Ray said.

In his work as a pediatric plastic surgeon, Ray has found a great deal of satisfaction. “It’s why I’m here,” he said. “I want to give children the best chance at as normal a life as possible.”