A New Technique for Skin Color Matching in Head and Neck Reconstructive Surgery

January 25, 2022
Dr. P. Daniel Knott, co-author

Following disfiguring cancer operations, patients may undergo facial skin reconstruction surgery. Skin is used from other parts of the body for this surgery, but this can lead to severe facial color mismatching, particularly among fair-skinned older adults whose faces are more deeply pigmented from lifelong cumulative sun damage. Thanks to a technique pioneered by UCSF surgeons, these patients will now have a much better facial color match.

In a recent study, a team from the UC San Francisco Departments of Otolaryngology – Head and Neck Surgery (UCSF OHNS) and Dermatology along with the Tripler Army Medical Center in Honolulu evaluated color match by comparing digital photographs of 68 patients treated for facial cancer, sarcoma (cancer of the soft tissue) and a single gunshot wound.

"Our study sought to quantify the degree of color match achieved during microvascular facial reconstruction, and to describe a novel technique for improving reconstructive skin color match," says P. Daniel Knott, MD, first author, professor and director of the Facial Plastic and Aesthetic Surgery at UCSF.  "Our team hypothesized that split-thickness skin grafts (STSG) placed atop de-epithelialized free tissue – known more simply as skin grafts with 'privacy glass' - produces better facial skin color match than free tissue with intact epithelium."

This important work was published in Laryngoscope, and it was recently highlighted in UCSF News

What's next? The eventual goal of UCSF surgeons is to have tissue tailored to each patient's color. "We would develop a paradigm that would offer the best color match from very pale to very dark. Different depths of skin grafts encompassing varied amounts of melanocytes, using different tissue sites and donor sites would enable us to modulate the eventual color to realize ideal color match," said Dr. Knott in UCSF News.

Senior author on this study was Bovey Zhu, MD, ENT-otolaryngologist at the Tripler Army Medical Center. Co-authors from UCSF OHNS include  Rahul Seth, MDAndrea Park, MD, and Chase Heaton, MD. Additional authors from UCSF include Mary Han, MD (CA1 Resident, UCSF Anesthesia) and Roy Grekin, MDSarah Arron, MD, PhDIsaac Neuhaus, MDSiegrid Yu, MD, and Drew Saylor, MPH, MD (UCSF Dermatology). Sean Alemi, MD, former UCSF OHNS resident, also contributed.  

Learn more about the UCSF Division of Facial Plastic and Reconstructive Surgery.