Craniofacial services at The Children's Hospital at Westmead

Contact details

Appointments and enquiries:

9845 0918 Mon-Fri 8am-4.30pm
Referral Fax: 9845 2078 
Location: Speech Pathology Department

This video on 3D printing and its contributions to craniofacial reconstruction was produced by 7 News Sydney as part of Radiothon 2018.

The craniofacial unit at the Children's Hospital at Westmead

We're one of the busiest craniofacial units in Australasia. We're dedicated to the care of children with facial differences. Our service comprises a multi-disciplinary team of specialist nurses, geneticists, plastic surgeons, neurosurgeons, speech therapists, eye specialists, paediatric radiologists, paediatric anaesthetists, dentists, orthodontists and orthotics specialists.

Craniofacial surgery is a diverse field covering conditions that children are born with (congenital) as well as those that develop (acquired conditions). We prioritise the treatment of children and their families in an open honest environment.

There are some conditions we see often, and other conditions which are rare or one-of-a-kind, so we treat every child and every family as unique individuals. The treatment plan is explained with the family’s full involvement. Every child is different so every child has a customised plan. We understand your concerns about treatments and anxieties about long-term outcomes for your child. We provide support and assurance in a thoughtful and compassionate manner.

Not all children seen in our clinic need surgery. Not all patients need x-rays or other investigations. Our goal is to continue to provide world-class care based on the best scientific evidence – evidence that we contribute to through our ongoing research activities.

This webpage contains information about the referral process, a brief overview of the conditions we treat and an introduction to the team.

Keep up to date with the latest information:

Conditions we treat


Craniosynostosis is the premature fusion of bones of the skull. Fusion of these bones may cause the head to grow into an unusual shape. It can also restrict the growth of the brain, leading to developmental problems. Craniosynostosis occurs in around 1 in 3,000 births. There are several different types of craniosynostosis.

The treatment for craniosynostosis usually involves surgery in order to remove the fused parts of the skull and give the brain more room to grow. The type of surgery will depend on the age of the patient and which bones of the skull have fused.

The timing of surgery depends on the type of craniosynostosis. At the Children’s Hospital at Westmead, we use advanced techniques ofmcraniofacial surgery such as helmets and springs, which are designed to both relieve and exert pressure on certain parts of the skull to moderate growth.

Some forms of craniosynostosis are genetic such as ‘syndromic’ craniosynostosis are Muenke syndrome, Apert syndrome, Crouzon syndrome, Sathre Chotzen syndrome and craniofrontonasal dysplasia. These conditions can affect the development of other parts of the body (such as the cheek bones, palate, hands and ears) and cause fusion of multiple bones of the skull. Children with these conditions need specialised treatment and long-term follow up.

Hemifacial macrosomia, Treacher Collins Syndrome

Some children have facial differences resulting from underdevelopment of the jaw bones and soft tissues of the face and ear. Hemifacial microsomia and Treacher Collins syndromes are conditions where parts of the jaw and ear haven’t developed properly.

Some patients need surgery on their jaws when they are young—such as a rib graft to reconstruct the jaw or surgery to ‘stretch’ the jaw, a technique called distraction osteogenesis.

Our paediatric dentists and orthodontists actively monitor tooth development and the child’s smile. We have an ear reconstruction team at the Children’s Hospital who can make new ears out of a child’s own tissue when they are around 11 years of age.

Positional plagiocephaly

Some babies develop flattening on one of both sides of the back of their head. This can cause an unusual head shape which is sometimes a result of the baby always sleeping on one side or always on their back.

Other causes include problems with head turning due to neck or muscle issues. There are a number of different names for this condition including ‘positional plagiocephaly’, ‘deformational plagiocephaly’ and ‘plagiocephaly without synostosis’.

The good news about this flattening of the back of the head is that is does not affect the development of the underlying brain and never needs surgery. Sometimes it is difficult to tell whether the flattening of the back of the head is just due to positioning, or whether it is caused by early fusing of the bones of the skull. For this reason, we like to see babies with this condition to reassure the parents (and ourselves) that nothing is going on that might need treating.



Please fax a written referral from your local doctor or paediatrician to the Craniofacial Clinic on (02) 9845 2078.

Please ensure that the referral includes patient name, address and phone numbers so that we can contact parents/carers with an appointment. Unfortunately, appointments can't be made without a referral.

Please forward X-rays, CT or MRI scans to us two weeks before your appointment, as we need to review these before the meeting. If you have not been asked to have scans there's no need to have any performed before the appointment.

Children attending the Craniofacial Clinic often have complex conditions and may need to be assessed by a number of health professionals during the consultation. The consultation time can vary for each child, so please allow additional time on the day of your appointment.

Meet the team

Dr Damian Marucci, Plastic and Reconstructive Surgeon

Dr Adam Fowler, Staff Specialist Paediatric Neurosurgeon

Dr Fowler graduated from Medicine at UNSW in 1998 with the University Medal. After spending time in as a Medical Officer in the Royal Australian Navy and seeing active service in Desert Shield, he returned to Sydney and commenced Neurosurgical Training. He completed his PhD in Molecular Genetics at the Kolling Institute of Royal North Shore Hospital and graduated in 2011.

He completed post-fellowship training at the Children’s Hospital, Westmead in Paediatric Neurosurgery and is an appointed Staff Specialist. He has written a number of publications and is a co-author of the Australian Glioma Guidelines. His clinical interests include spina-bifida and craniofacial reconstruction.

Dr Robert Gates, Plastic and Reconstructive Surgeon

Dr Gates is one of Australia's most experienced and leading plastic surgeons. Following his completion of training in Sydney, Dr Gates did further fellowship training in Oxford. He has been working treating cleft and craniofacial conditions at the Children's Hospital at Westmead for the past 20 years.

Dr Gates is currently the Head of the Department of Plastic Surgery at the Royal North Shore Hospital, as well as being a clinical examiner for the Royal Australasian College of Surgeons.

Dr Gates performs volunteer surgery in developing countries every year with Interplast.

Dr Janine Smith, Staff Specialist - Clinical Genetics

Dr Julia Dando, Specialist Orthodontist

Research interests

The Craniofacial Unit is involved with numerous research projects through our affiliation with the University of Sydney. Our research activities are extensive and ongoing.

Here's a look at some of our current projects:

Use of springs in craniofacial surgery

Spring cranioplasty is a minimally invasive way of changing the headshape in children with sagittal synostosis (scaphocephaly) and bicoronal synostosis (brachycephaly). The Craniofacial Unit has been an early adopter of this revolutionary technique.

Assessment of post-operative results using 3D photography

The Children's Hospital at Westmead has a state-of-the-art 3D MD camera which allows 3-dimensional images of a child's head to be taken in a fraction of a second. Before and after photos can be compared for changes in appearance and volume. We are currently evaluating the long-term cosmetic results of our surgery to make our procedures more effective.

Minimising blood loss in craniofacial surgery

Craniofacial procedures can involve major blood loss. Our review of our data from the past 10 years is illuminating which techniques are most effective to limit blood loss during surgery, and so make the procedures safer for children.

Parental satisfaction with inpatient and outpatient services

The Craniofacial Unit is leading an ongoing audit of parental satisfaction with our outpatient clinics and inpatient services. We review these patient satisfaction surveys on a regular basis. Our goal is to achieve continuously better patient care and outcomes.

Fellowship opportunities

The Children's Hospital at Westmead has fellowship opportunities for suitable applicants. Ideally, applicants should be near the end of, or completed their speciality training, in Plastic and Reconstructive Surgery.

The Plastic Surgery Fellow will be exposed to cleft, craniofacial, general paediatric reconstructive surgery and burns. Six and twelve-month positions are available. Opportunities also exist for research and teaching/on call commitments as part of the workload.


Please contact Dr Damian Marucci by emailing the Craniofacial Secretary.