When a baby is born, the bones of the skull are meant to behave like the slats of a wooden barrel, flexible enough to slide into the correct orientation as the brain beneath them doubles in size during the first year of life. However, in about seven of every 100,000 births one of those seams between the bones of the skull (called a suture) closes too early along a single side of the forehead, a condition called unicoronal synostosis (or UCS). Instead of rounding out evenly, the skull twists: one brow pulls backward, the opposite brow juts forward, the eye sockets tilt, and the nose shifts off‑centre. Beyond cosmetic considerations such as the visible asymmetry, these children can also face raised brain pressure, vision problems and slower development.

Facial reconstruction is one of the most challenging fields in cosmetic and reconstructive surgery. When patients undergo skin transplants to address large facial defects, the surgeon’s goal is to restore both the function and appearance of the face in a way that integrates seamlessly with their natural features. Dr Xusong Luo, Dr Lin Lu and their colleagues at Shanghai Ninth People’s Hospital have developed an innovative approach that offers a promising new option for repairing large facial defects, particularly in children born with giant congenital melanocytic nevi.