Bagram, Afghanistan — For Air Force Lt. Col. Carlos Ayala, M.D., serving as a facial plastic surgeon at Bagram Airfield in Afghanistan is a stark contrast to what he experienced during his fellowship at the Lasky Clinic in Beverly Hills, Calif. But he’s applying many of the same esthetic principles, as he attempts to reconstruct faces torn apart by war.
Dr. Ayala, who has been at the Craig Joint Theater Hospital at Bagram Airfield since May 2011, is the only American facial plastic surgeon practicing in Afghanistan, and possibly the only facial plastic surgeon in that country — period. He is charged with providing care to U.S. service members injured in battle, as well as local nationals and Afghan National Police. While the bulk of his time is taking care of injured military, he has also treated local people with congenital problems.
Air Force Lt. Col. Carlos Ayala, M.D., 455th Expeditionary Medical Group, chief of ear, nose and throat/facial plastic surgery, at the Craig Joint Theater Hospital. (Photo credit: U.S. Air Force)
Dr. Ayala is confronted daily with people whose injuries are so devastating, they are not yet described in textbooks.
“You never really know what’s going to come in the door,” he says. “I’m learning how to deal with … complex blast injuries and putting these patients’ faces back together to as normal an appearance as possible.”
Dr. Ayala says he sees a lot of head and neck trauma, secondary to improvised explosive device (IED) blasts, as well as gunshot wounds to the face and neck with high-velocity weapons. His patients commonly have mandible fractures, neck wounds, airway problems and facial burns.
Medics first provide life-saving emergency care in the field before transporting injured military personnel to Craig Joint Theater Hospital.
“I then go on to stabilize them, provide further life-saving care and begin to repair their wounds, removing the shrapnel and debris from their faces and necks,” Dr. Ayala says.
The facial plastic surgeon completes some repairs in Afghanistan, or he stabilizes patients for continued treatment and transport to Germany or the United States.
“Sometimes, we’re not able to remove all the fragments because basically their faces are peppered with these fragments. So we take out the biggest and as many as we can,” Dr. Ayala says. “Eventually, they do end up with some type of traumatic tattoos, where this debris is still in the skin. But we try to limit that by really scrubbing their faces and removing all this before they go on (for further treatment).”
Dr. Ayala, who went to the David Geffen School of Medicine at University of California, Los Angeles, and completed his ENT residence in Harvard’s otolaryngology program, says he has learned to override his desire to fix things as quickly as possible.
“I think the biggest pearl is not to rush. The wounds are very dirty from the blasts, and the first impulse is to fix everything. The reality is that it’s better to wait and let things sort of settle down and slowly begin to repair them,” he says.
A day in the life
Dr. Ayala says he has forgotten what it’s like to sleep. He’s on call every other day, for basically 24 hours.
“We’re just waiting for traumas to come in. The rest of the time, you’re operating nonstop on trauma patients … or you’re seeing patients in the clinic that you operated on,” he says. “This hospital runs 24 hours, seven days a week, doing nothing but trauma care.”
He goes home in November 2011 and retires soon after.
“I will continue to work at Nellis Air Force Base, where I’m stationed, and in a year and a half, I retire from the military,” Dr. Ayala says. “ My commitment will be done with the military, so I can go into the civilian sector. I’ll be looking for a place to be a facial plastic surgeon. My interests are cosmetic surgery, as well as reconstructive surgery.”
But there still is much to do for the injured in Afghanistan.
“The soldiers, sailors, airmen and Marines … these guys are heroes, and I’m very proud to be here to take care of them. As far as the local nationals … the care we provide is probably the best care that they have available here in the country. Once we let them go, they’re back on the local economy, and the level of care is nowhere near our level of care,” he says.