Craniofacial surgery beyond childhood: Miles Pfaff, MD on cleft, microtia and ear reconstruction

In this episode of Physician Huddle by UCI Health, Miles J. Pfaff, MD, assistant professor in the UC Irvine Department of Plastic Surgery, traces his path to plastic surgery and explains how craniofacial surgery has grown well beyond its traditional roots in pediatric congenital care. With a practice spanning both adult and pediatric reconstruction, Pfaff offers a unique vantage point on where the specialty is headed.

The conversation moves through the intersection of research, surgical craftsmanship and clinical innovation, from cleft lip and palate care and ear reconstruction to donor cartilage, evolving rhinoplasty techniques and the promise of 3D-printed reconstructive options. Pfaff also reflects on what draws him to academic medicine, how he approaches training the next generation of plastic surgeons, and why the long-term relationships he builds with patients and their families remain among the most rewarding parts of his work.

Topics discussed: 

• Craniofacial and craniomaxillofacial surgery for pediatric and adult patients at UCI Health and Rady Children's Hospital (formerly CHOC Children's Hospital). 
• Cleft lip and palate repair: Staged surgical care from infancy through adulthood, including bone grafting, jaw surgery, and cleft rhinoplasty.
• Microtia and total ear reconstruction: Autologous rib cartilage, synthetic (Medpor) frameworks, and allograft donor cartilage techniques.
• Allograft ear reconstruction with donor costal cartilage: Reducing an 8–12 hour surgery to 3.5 hours with same-day discharge.
• Closed rhinoplasty and dorsal preservation rhinoplasty: Functional, cosmetic, and reconstructive nasal surgery.
• The future of 3D-printed ears, noses, and biocompatible reconstructive implants.
• Dr. Miles Pfaff's training: plastic surgery residency at UCLA and craniomaxillofacial fellowship at UPMC Children's Hospital of Pittsburgh
• Research at the UCI Center for Tissue Engineering: Nearly 100 peer-reviewed publications.
• Leading UC Irvine's plastic surgery residency program as program director, plus fellowships in hand surgery, craniofacial surgery, microsurgery, and aesthetics.
• Long-term patient relationships: following cleft and craniofacial patients over 25–30 years.

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