Fernando D. Burstein, M.D., F.A.C.S., F.A.A.P.
Board Certified in Plastic & Reconstructive Surgery
Board Certified in Otolaryngology (head & neck) Surgery
Director of the Center of Craniofacial Disorders for CHOA
Located at our Northside Location
Pediatric Plastic & Reconstructive Surgery
Every parent wants what is best for their child. That is why when a child is born with a congenital defect or facial deformity, it is of the utmost importance that their condition is treated by an expert in pediatric reconstructive surgery of the face. Dr. Burstein is a board certified plastic and reconstructive surgeon, trained in Otolaryngology / Head and Neck surgery at the University of California, Los Angeles (UCLA), specializing solely in surgeries of the face, head, and neck. In addition to his cosmetic and reconstructive work at Atlanta Plastic Surgery, Dr. Burstein co-founded the Pediatric Plastic Surgery & Craniofacial Associates (PPSCA). His goal is to offer the very best in surgical pediatric care to ensure your child a chance at his or her best possible future.
Click on a procedure listed below to read more.
Congenital disorders are those deformities and medical conditions that are present at the time of birth. Most congenital disorders are more successfully treated and corrected when a person is still an infant, or a small child, ensuring the best and most “normal” possible future for the patient. Not all congenital disorders are genetic or easily detected at the time of birth, and must be diagnosed by a qualified dysmorphologist (a specialist in genetic related disorders) or a physician specializing in pediatrics. Congenital disorders of the face, head, and neck – like those treated by Dr. Fernando Burstein of Pediatric Plastic Surgery & Craniofacial Associates – can range from fairly common (cleft lip / palate) to extremely rare.
Reconstructive surgery specializing in the correction of diseases, disorders, defects, and injuries of the head, neck, face, and jaws is called maxillofacial surgery. Many defects treated through maxillofacial surgery are caused by congenital disorders, or medical conditions present at birth, and are recommended to be treated while a patient is still a young child. Pediatric Reconstructive Surgeon, Dr. Fernando Burstein of Pediatric Plastic Surgery & Craniofacial Associates and Atlanta Plastic Surgery is a board certified plastic and reconstructive surgeon with training in Otolaryngology/ Head & Neck Surgery, and is world renowned for his reconstructive facial work and maxillofacial surgical techniques, including pediatric surgery.
A sub specialty of maxillofacial surgery is craniofacial surgery – corrective surgery that targets congenital abnormalities and defects of the face, jaw, and skull. Since most congenital abnormalities are detected and treated at birth (or at a very young age), it is recommended that patients seek surgeons that specialize in pediatric facial reconstruction. Atlanta reconstructive surgeon, Dr. Fernando Burstein completed a Craniofacial Surgery Fellowship at UCLA in 1989 and is currently serving as the Medical Director for the Children’s Healthcare of Atlanta’s Center for Craniofacial Disorders. World renowned in reconstructive surgeries of the face, Dr. Burstein utilizes the latest techniques for the correction of abnormalities such as cleft lip and palate, mandibular abnormalities of the jaw, and abnormalities of the skull.
A cleft deformity, present during birth, can occur along the roof of the mouth (called a cleft palate), can be on either side or both sides of the nose (called a unilateral or bilateral cleft lip), or can be complete or incomplete depending on the presence of bridging tissue across the split. Surgery of the cleft lip or palate to correct this congenital deformity is most commonly performed on babies or young children to give the face as much of a normalized appearance possible before the child reaches “school age.”
Infants born with a cleft lip or palate may have trouble eating and speaking properly, have missing teeth, have a misalignment of the teeth and jaw, and subsequent nasal deformities. These issues will be addressed by your pediatric reconstructive surgeon during craniofacial surgery to restore full function and correct the appearance of the face. Patients often require more than one surgery to close the cleft, restore full function, and improve facial appearance. Each craniofacial surgery lasts about 2 to 3 hours and typically requires a 3 day recovery period.
Cleft lip surgery works to correct not only the lip, but the muscles around the lip and the nose also – all which can affect the function and look of the facial area. Preparation for the surgery usually begins at two or three weeks of age, as long as no other health problems are present in the infant. If a clean bill of health is given, the surgeon starts to work with the skin by using special taping across the split/cleft or a small device within the patient’s mouth. The corrective surgery, which can be the first of a series of corrective surgeries depending on the severity of the deformity, is typically completed by the time the child in only 3 months of age.
Some cleft lip patients also have a cleft or split in the alveolus, the bone which holds the teeth in place. While this is most commonly corrected when a child is about 8 years old, it may be addressed during an earlier surgery is the deformity is milder.
Very often cleft lip patients are also born with a gap or split in the roof of the mouth, called a cleft palate. This separation of tissue may run though all or part of the roof, and rarely, can be related to the lower jaw, known as the Pierre Robin Sequence. The correction or treatment of a cleft palate is especially important for infants because this defect oftentimes gets in the way of feeding – making it difficult or impossible for child to create suction. In these cases, specialized bottles and nipples may be used or a device may be place in the child’s mouth to ensure that they are getting the nutrients they need. Even if the child can feed properly, surgery of the cleft palate is recommended at a very early age so that children do not form incorrect speech habits once they start to talk. Ear infections are very common with cleft palate babies, so make sure you as a parent are aware of this issue (and its symptoms) if you have an infant born with a cleft palate.
Because of all of the issues and complications mentioned above, cleft palate surgery is typically performed by a pediatric reconstructive surgeon, like Dr. Fernando Burstein, when a child is 6 to 7 months of age.
Abnormalities of the jaw in children are most commonly a result of congenital defects (medical conditions present at birth) or the result of trauma or an accident. Congenital defects of the jaw can affect the lower or upper jaw (or both) and can exhibit symptoms including protrusion or recession. For more severe deformities of the jaw, dentofacial surgery performed in conjunction with an orthodontist and/or dental specialist may be needed to correct the misalignment of the jaw and teeth. Dr. Burstein uses a variety of techniques including: minimally invasive distraction osteogenesis, bone reduction and reshaping, facial implants, and repositioning of the jaw bone to correct child jaw deformities.
Upper Jaw Deformities / Abnormalities
• Upper jaw deficiency
• Short face deformity
• Long face
• Open bite
• Upper and lower jaw asymmetry
• Upper and lower jaw misalignment
• Craniofacial deformities (congenital)
• Craniofacial deformities (trauma)
• Maxillofacial deformities (congenital)
• Maxillofacial deformities (trauma)
Lower Jaw Deformities / Abnormalities
• Jaw protrusion
• Jaw recession
• Sleep apnea
• Jaw fracture
Often children with deformities of the chin are born with either a small (recessed) chin or an enlarged (protruding) chin known as mirognathia and macrognathia, respectively. For a small chin, the pediatric surgeon can either surgically move the chin forward, known as an Osseous Genioplasty or bony chin advancement, or enlarge the area through use of an artificial implant. Surgery of the chin not only dramatically improves the overall aesthetics of the face and profile in children, but can prevent strain to muscles in the neck that are attached to the chin.
For children with abnormally large chins, chin reduction surgery by a pediatric reconstructive surgeon is recommended. Often, deformities of the chin appear with deformities of the upper and lower jaw and/or the nose. As with surgeries of the jaw, pediatric reconstructive surgeons and a dental specialist like a qualified orthodontist must work together to fully correct form and function.
Every person’s skull is comprised of fibrous joints called sutures. When congenital defects of the skull, called craniosynostosis, occur in children it causes various sutures to fuse improperly or prematurely, resulting in an abnormal head shape in infants. Some other abnormalities of the skull, such as a flattened head shape, develop after birth as a result of skull bones moving to the improper place during the birthing process. Whatever the cause of the skull abnormality, corrective and reconstructive surgery of the skull by a board certified Otolaryngologist (face and neck surgeon) is recommended as soon as surgery is possible for the child. In fact, surgery of the skull is recommended before a child reaches one year of age, because of the developmental implications.
Craniosynostosis is fairly common, occurring in about 1 out of 1000 births. Here are some of the most common deformities of the skull that plastic and reconstructive surgeon and Otolaryngologist Dr. Burstein of Pediatric Plastic Surgery & Craniofacial Associates treats:
• Multiple Suture Fusion
• Suture Fusion Associates with Other Congenital Defects
• Positional Head Deformity
Diagram of surgery
2 years post-op
Deformities of the ear in children can be congenital or isolated, very mild or very complex. But unlike most other deformities in children, ear surgery (also known as Otoplasty) is often performed after age 6 – when the ears are said to reach “adult size.”
Because of the complex shape of the ear, and unique position on either side of the head, ear reconstruction can be a very complex surgery and should only be entrusted to a surgeon with training in Otoplasty and reconstructive surgery of the head and neck. Depending on the deformity or defect present, Dr. Burstein utilizes various corrective surgical techniques such as skin grafts, flaps, and primary linear closures to restore the shape, size, and alignment of the ear.
Common Deformities of the Ear include:
• Absence of an Ear
• Prominent Ears
• Constricted Ears