Dubai: A young woman with fourth degree acid burns to her face that completely dissolved her features, melted her eyelids actually walked out of a Dubai hospital with confidence and most of her face restored in a series of surgeries carried out in a span of two years, thanks to the incredible work of a Dubai-based plastic and reconstructive surgeon.
In one of the rarest of rare instances of reconstructive surgeries, Dr Mohan Rangaswamy, chief plastic surgeon at the American Academy of Cosmetic Surgery (AACSH) at the Dubai Health Care City (DHCC), fashioned a nose from the rib bone and cartilage on the forearm of the acid victim — Heba Hosni.
Dr Mohan let it mature with blood supply on the forearm before transplanting it on her face assisted with micro-vascular surgery. The result seems right out of a sci-fi book where a patient with a stub of a nose now has a real nose on her face apart from the many other aspects on her face that were worked on to give her face a near semblance of normality.
Giving an acid attack victim a fighting chance at life
The pictures of the patient before and after the surgeries bring out the extent and the severity of her injuries, as well as the work that was done on them. It elevates the results of the eight surgeries that the resilient woman underwent into a work of art. It restored the dignity of a proper life to this brutal acid attack victim whose tale of courage and endurance and undying hope sends out a strong message to other victims of burn injuries and other forms of domestic violence.
The story of Hosni, 38 as she he flew back to her country, in the last week of January 2021 — smart, restored and confident-, is that of grit, courage, tenacity, ingenuity and above all, the triumph of human spirit.
I fell and my face was on fire
In 2008, Hosni, a then 26-year-old Egyptian young divorcee with a son was working hard to keep her life going. As a hair dresser at a salon, this single mother made enough to be able to manage her boy’s expenses even as Hosni’s mother and other family members supported her bringing up little Abdul Rahman while she worked at the salon. A few years on, Hosni had gathered the courage to warm up to the advances of a suitor and was dreaming of a safe, secure and happy life. However, something about this suitor was aggressive and distressing so Hosni decided to end the friendship and turn down the offer.
It was only a few weeks after that break-up, recalled Hosni, narrating her story to Gulf News. “The day, the date and time when my life changed so horribly is etched in my mind — May 29, 2008, 9.30am. I was hurrying to the salon, walking on the road when this man who I had broken off with, suddenly accosted me on the street and threw what seemed like a bottle of water on my face. I fell down and felt my face was on fire. The pain was so intense that everything felt numb after that. Someone called an ambulance. I felt my face had frozen and my hair had all burnt up, I was in complete shock.
I suffered horrible pains
However, the ordeal had only just begun for Hosni. She had to travel from one hospital to another where few people had any idea of treating her deep burn. An ordeal that began in 2008 continued for six long years. At the first hospital she stayed for three weeks, where they did only dressings and then sent her home. After staying home for a month, during which she progressively lost her vision, and was taken to another bigger hospital.
At this hospital, Hosni spent six months as doctors debrided her dead skin, cleaned out her melted eyelids and nose and upper lip and just tried to keep her infection low with strong doses of antibiotics. As the young woman went from hospital to hospital, her dreams of love and marriage evaporated in the aftermath of the brutality as she endured painful surgeries for cleaning, debridement and skin transplants from her own body to cover the deep burns on her face.
Jibes and humiliations
Once the hospitals ran out of treatments, they discharged her and the only thing the young girl could look forward to, was the dark abyss of ignominy and humiliation. “After that the hospital sent me home, with the sharp bones of my face, jutting out through the charred skin and empty eye sockets and a nose stubble, I could not face the world.” The kids on her street threw stones on her and called her names. “Despite all the insults and humiliations, I was thankful to God I was breathing and I nurtured hope for myself, thinking of ways to get out of this, be there for my son,” said Hosni, who began contacting victims of acid burns on the net.
There were many and eventually, a few of them reached out to her and told her about Dubai’s Prosthetic Sculptor Ashwaq Hassan Al Hashmi of Omniyati Prosthetic Arts Centre and Hosni reached out to Al Hashmi to pick up the pieces of her life.
Victims of acid attacks
Al Hashmi, a former Prosthetic Sculptor at Rashid Hospital Dubai who used acrylic and other material to create prosthetics for patients of burns or those born with congenital deformities told Gulf News, “I had been working with victims of acid attacks from Pakistan. One such documentary film made by Pakistani film maker Sharmeen — Obaid-Chinoy, on two acid attack women, were awarded with an Emmy and Oscar honour for the best documentary film. I had worked with these victims and used my skills to help many other women. So these Egyptian victims, including Hiba reached out to me for help, When I met Heba, she was so broken psychologically that I knew I had to help her. I became her emotional anchor. A generous anonymous benefactor from Saudi Arabia, who had seen her interview on television, came forward to help finance her treatment. That is when, I introduced her to Dr Mohan. The financial help from her generous benefactor gave her the chance to dream for more.”
A glimmer of hope at last
In 2018, Hosni came to Dubai and met Dr Mohan, that changed her life forever. Describing this as one of the milestone cases in his medical career, Dr Mohan recounted, “When I met Heba through Ashwaq, the young women was nothing but skin and bones. We hear of third degree burns, but Heba had fourth degree burns. In her eyes even the structures beneath the skin had been charred. She required skin grafts on bone in many places. Her eyes had submerged in the socket, and her nose and upper lip were lost as well.”
Without losing time, Dr Mohan and his team began working. In a series of fat grafts carried out from the patient’s body, the healing process was initiated. The team began with processed fat grafts containing her own stem cells from elsewhere in the body to heal the face scars, inject volume and given the facial parts a healing skin cover.
Dr Mohan worked to reconstruct the upper and lower eyelids so that the artificial eye could look natural; next he reconstructed the upper lip. Dr Mohan recalled, “Heba then did something she was afraid to do for many years, she washed her face and overcame her fear that her facial skin would come apart with the wash. When I watched the video of her performing this simple act with great trepidation initially and then with a whoop of joy, it was a moment that both Ashwaq and myself will never forget,” he recalled.
Growing a nose for Heba
“Now there was some working structure on the face, however, the patient had no nose,” recalled Dr Mohan, leaving it to Ashwaq to create a prosthetic nose.
However, this is where the brave victim, who was willing to endure pain to get a real nose, put her foot down. “Hiba was adamant that she would not hear of a false nose that came off like her prosthetic eye at night. She told me that since I had been able to restore her cheeks and other features, I had to think of someway for giving her a permanent nose. The skin on her face and arms had burnt off and I had no idea how I would do it. But her faith in me, set me thinking. After much thought and some reading, I had a eureka moment,” recalled Dr Mohan. “First, a tissue expander was placed underneath the skin of her forearm to create more volume moment when the plan crystallised in my mind.”
In the next surgery, the expanded skin was lifted up and shaped it like a nose with help of wires. Cartilage and bone from her rib was used to provide create the internal skeleton of the nose. Dr Shahram Sajjadi, plastic surgeon at the AACSH, was a key collaborator in this surgery. Once that was done, the nose- shaped natural structure was allowed to rest and mature and heal on the forearm where it looked like the forearm had sprouted a nose. It even had the design of nostrils and columella incorporated into it, recalls the doctor.
A microvascular transplant miracle
In a few weeks when the ‘nose’ had matured and healed, the patient was taken to NMC Royale hospital where Dr Abizer Kapadia another plastic and reconstructive surgeon with specialisation in microvascular surgery assisted Dr Mohan in lifting this tented nose-like structure and transplanted it to the face.
Dr Mohan added, “All the facial vessels of the patient had got burnt. The challenge was to connect the microvascular system of the transplanted nose on the face and connect it to the vascular system to get a blood supply. We used the veins and arteries from the neck to create this connection. The adjacent cheek skin was integrated in a flap surgery to create the inner lining skin of the nose over which this structure was sutured. Once the blood supply through the microvascular system was connected, the nose simply became part of Hiba’ face.
Chiselling the nose in its final shape
“The nose initially looked very big and like an external blob, but with subsequent surgeries it was chiselled into shape,” recalled Dr Kapadia, who is currently working with the Al Zahra Hospital, Dubai.
In two recent procedures carried out during the pandemic period, the nose was chiselled into a refined shape, using Piezo technology of tissue sculpting. Dr. Mohan acknowledged the help and inputs by Dr. Sajjadi at this stage again.
The young woman now had a smile, a nose and despite the scars, the results were nothing less than a miracle. The patient’s hair grew back and in places where the roots were charred, Carole el Khaoule, a make-up artist who specialises in semi-permanent make-up and magic tattoo, worked on the scalp to create a semblance of volume. As a gesture of showing solidarity with the victim, el Khaoule rendered her services, free of charge. She also created eyebrows and lip definition for Hosni.
Hope for help to restore some eyesight and heal more scars
The anonymous benefactor who selflessly provided funds for these series of nine surgeries now could not pay any longer. Hosni, happy with the surgeries and with a smile on her face returned with hope to Cairo in the last week of January 2021, excited to meet her son, who is 21 now, and her family. If she is hiding the invisible pain of the horror of the attack, behind the smile, Hosni has come out with flying colours.
She had a message for other victims. “Never lose hope, or the will to live. Fight to be heard, keep your belief in God intact and have faith that there are such wonderful people in the world like the team of doctors and my anonymous benefactor, who have changed my life. I know I need more surgeries to make my nose better, my left eye can only perceive light and I am hopeful that some other benefactor will come forward to help me regain some vision. However, for now my only wish is to walk on the road with my face towards the sky and feel the breeze on my face.”
First aid for acid burns
As a victim of an acid attack quick action can make a big difference, said Dr Mohan. Never store strong acids and alkalis [drain cleaner powders] and never treat these casually and keep it out of reach of children. However if an accident does happen here are the immediate steps of first-aid
* Wash the whole affected area with copious amounts of plain water to dilute the acie and wash it away. This is even more important than calling the doctor or rushing the victim to hospital and needs to be done immediately.
* All clothing must be removed after the initial wash;
* Make the victim stand under a shower to wash off all residues for 5 minutes.
* If the face is affected, wash the eyes with running saline solution, one can prepare saline solution in a few seconds by dissolving a teaspoon of salt in 1 litre of water. Plain water irritates the eye and the victim may shut her eyes.
* Make sure to open the eyelids gently and the saline must be used continuously for a minute at least to wash off the acid.
* After this apply Vaseline or clean vegetable oil can be applied to burn areas and the victim taken to a hospital emergency.
Heba’s journey timeline
1. to create fornix and eyelids for right eye prosthesis
2. Improve tightness in the whole face by fat graft
3. Release tight scars
1. to improve fornix and eyelids for right eye prosthesis
2. Further improve tightness and bring soft tissue
3. Reconstruct right lateral nasal wall
4. Create upper lip
5. Full face fat graft
1. Release tightness of mouth
2. More fat graft to face
3. Insert expander balloon in right forearm to make more skin for fabrication of nose
Nose was prefabricated in a 6 hours long procedure by taking rib bone and cartilage, fashioning the framework and creating all elements of the nose on the forearm itself. At the end we had a ‘nose’ on forearm.
The ‘nose’ was taken together with its blood supply vessels and attached by microvascular surgery to the vessels of the neck. The inner lining was created. The bone of the new nose was attached to existing bone stump by two screws. Some part of this reconstruction could not be completed due to massive swelling
Completion of the reconstruction 8 days later, after swelling subsided
The new nose was thinned and sculpted from the right side. Fat grafting to the face and the right eye was improved further
Eighth 16.11.2020 [delay due to Pandemic]
1. The nose was thinned from the left side, bone was sculpted using Piezo technology
2. Hairline was brought forward
3. upper lip was lifted
4. Left eyelids improved
5. Fat grafting to the whole face again
6. Full thickness skin grafts placed in preparation for eyebrow tattooing
1. Perfection of nostrils
2. Augmentation of upper lip left side
3. Scars revised
4. Injection of SVF cell mixture for softening of all scars and to bring regenerative cells to her face.
Over to make-up and tattoo artist
1. Eyebrow tattoo by microblading on grafted skin
2. Permanent lip liner
3. Lip filler
4. Tattoo for the hairline with missing hairs
5. Hair styling and colouring
6. Eyeglasses to complement her face