Smile! Have you ever thought of surgery on a smile?  Probably not, but today’s blog from Sarasota Cosmetics Surgery Group brings you the unusual story of surgery on a smile, specifically, a smile gone wrong.  “The smile has been judged as the most important sign to express positive emotions, and people are judged to be angry when they can’t smile,” says Kofi Boahene, M.D. of Johns Hopkins.

Before we begin this story about How to Fix a Smile, let us clarify that one of the functions of the Sarasota Cosmetic Surgery Group Blog is to bring you news in the particular fields of plastic and cosmetic surgery.

This week we feature a reconstructive procedure that has made news both at Johns Hopkins and in Britain.  With the new technique, plastic surgeons treat facial paralysis which affects half of the face. They can restore the ability of the affected side to match the good side of the face.  Thus they make it possible for the patient can smile.

Johns Hopkins Announces Perfection of Smile Surgery

Whenever new or impressive work is being done in plastic surgery, we like to report it to you.  Thus, you can expand your knowledge of this medical specialty.  It does not mean that this type of work will be done here.  It only means that the new, perhaps even experimental procedures are making news somewhere.

Johns Hopkins has released

New surgical techniques help restore a natural smile after half the face is paralyzed. In some cases. Bell’s Palsy, Stroke or Tumors can ruin your smile. 

So this week’s blog brings you quite a story of research and meticulous surgery on the human smile.  These types of blogs from Altiora Plastic Surgery & Medspa are like news stories, meant to update you about the latest news and views in the world of plastic surgery.

The Wide, Even Smile:  An Expression of Facial Joy

Kofi Boahene, M.D. is specifically an associate professor of otolaryngology-head and neck surgery and dermatology at the Johns Hopkins University School of Medicine.  He spoke of older techniques for helping patients with partial facial paralysis:

He stated,”Previously, the best we could hope for most of the time with surgery was a smirk where just the corners of the mouth upturn in a smile like the one Mona Lisa has in DaVinci’s famous painting.  But that isn’t a joyful, expressive smile where the lips move up, teeth show and eyes narrow.  He and his team have been working on restoring authentic smiles to patients with such face deforming conditions as:

  • birth defects,
  • stroke,
  • tumors
  • or Bell’s palsy.

Now they have perfected some techniques that have led them to state, “Now we’re able to really able to restore a true“smile.  Make no mistake, he means they can now restore the authentic facial expressions of joy – the wide and even smile.

Never Underestimate the Power of a Smile

A smile is a feature within your face.

An even, broad smile is a big asset to your personality, confidence and ability to express yourself.

Meanwhile, the serious plight of these patients has also been news in the United Kingdom.  There authors of Smile Restoration for Permanent Facial Paralysis, wrote, “The loss of facial expression and the disfigurement of facial paralysis have serious implications for a patient’s physical and psychological well being.”

They noted that once nerves did not recover for 2 years, surgery is required to correct the problem.  They add, “Facial paralysis is often treated as an aesthetic problem but can also have real physical and psychological problems.”

Such problems include:

  • difficulty with speech,
  • low self-esteem,
  • poor social interaction,
  • drooling,
  • oral incontinence,
  • and dental problems…

Likewise, they saw patients with extreme caries (dental decay) “and repeated trauma and ulceration caused by biting of the inside of the paralyzed cheek.” Thus, they empathized with their patients.

Plastic Surgery can fix a smile. It is a reconstructive art as well as aesthetic.

Plastic Surgery is sometimes reconstructive and restorative. It not simply aesthetic.  Johns Hopkins fixes smiles that have been paralyzed.

Johns Hopkins’ Smile Fixing Technique.

Without getting too technical, the surgeons at Johns Hopkins reported special surgery for patients with one-sided facial paralysis thus:

1.  By modifying a muscle transplant operation, surgeons transplanted muscle tissue from a person’s thigh that pulled up on the paralyzed side of the mouth.

2.  In the modified procedure, the surgeon uses gracilis muscles from the thigh.  He places them in two directions and sometimes three. They are implanted at the corner of the mouth or the upper lip, to the cheek and eyelid to recreate an authentic smile that shows teeth and gum on both sides of the face.

About the Recent Smile Study in the News

At Johns Hopkins, “The surgeons published their findings on 12 adult patients, along with measurements of improvement, online March 22 in JAMA Facial Plastic Surgery.

Like the British scientists quoted above, Boahene notes that one-sided facial paralysis “creates social awkwardness and depression, making those who have it self-conscious about their appearance when speaking or eating in front of others.”  He added, “It also creates a tendency to drool and difficulty with normal blinking, which can cause dry and uncomfortable eyes.”

12 Patients and 12 Smiles in the Study

The Patient Roster: 12

The surgeons welcomed 10 women and two men between the ages of 20 and 64 to the study.

A smile need not be beautiful, but it is uniquely “you.”

The Preparation: 

The physicians videoed and measured:

  • the type,
  • angle
  • and degree

of smile on the nonparalyzed side of the patients’ faces.

The Surgery:

1.  During the operation, the surgeon positioned the new muscles so that they “pulled the lips up to match the non-paralyzed half-smile when contracted.”

2.  They rerouted blood vessels and one or more types of nerves to the transplanted tissue from the nonparalyzed side of the face.

3.  The genius behind the surgery was that “when the nerves on the nonparalyzed side send a signal for the muscle to contract, forming a smile, they do so for the paralyzed side of the face, too,” Boahene said.

The Happy Results:

We are happy (smiling) to report that within 4 months, all 12 participants had a function in the transplanted muscle.

  • They showed three teeth when smiling on the newly functional side of their face.
  • They exposed 43.7 millimeters of gum during smiling.  Before surgery, they only had 31.5 millimeters that showed.
  • Wrinkling around the eyes when smiling was observed in four of the 12 people after surgery.

“The surgeons also said asymmetry, or differences between the corners of each side of the mouth, was reduced from an average of 9.1 millimeters to 4.5 millimeters after surgery in the patients, making their smiles more even.”

Personal Commentary from the Surgeon

Dr. Boahene sees some people come soon after their paralysis and others exhaust all rehabilitation options before coming to him as a last resort.  He states “For me, joy is to see a child who has never smiled or someone who has lost their smile to paralysis be able to smile; you just see people transform.”  And he adds “In the past, we were restoring fake smiles and now our patients’ new smiles are so contagious that you can’t help but smile back.”

Other bits of Good News from the Research

It does not seem to matter how long the patient has been paralyzed.  If the patient’ gracilis muscle is weak, doctors can utilize alternative muscles.

None of the patients reported any side effects.  But doctors continue to warn there is always a possibility for swelling at the site where the muscle was removed.  They also added that “Some patients may need minor adjustments in the muscle tension to optimize their smile and symmetry.

Another Role for Botox to Play

In addition to surgery, Botox injections have helped in these cases, prompting the UK researchers to write, “The most common isolated branch palsy is that of the marginal mandibular branch; this results in uncontrolled excessive retraction of the lower lip on the normal side…”

Smile fixing sometimes requires Botox as well as surgery.

Botox is for more than beauty. It has a multitude of other medical applications.

And they add, “Botulinum toxin A (Botox) can be injected into the healthy side of the face every 3 to 6 months in order to restore symmetry.

Botox may also be used to improve involuntary twitching and fasciculation or synkinesis, which is often experienced during a patient’s recovery from a Bell’s palsy, but it may also be a permanent symptom.

Equally, the healthy muscle can be resected to improve posture.”

The happy, smiling image of the post-operative patient who had suffered facial paralysis is worth a visit to the above linked online resource.   Plastic surgery restored her smile.

The Terrific Take-Away from Altiora Plastic Surgery & Medspa and the Sarasota Cosmetic Surgery Group…

Now, Johns Hopkins patients will be able to choose a natural smile over the simple turned up corners of old-style facial corrective surgery of this type.  People called the older corrective surgical technique the “Mona Lisa” smile because of its turned up corners and artificial expression.

Thank you for reading our Altiora Blog.  In addition to reporting this to you as a news item, we thought of how blessed we were.  How blessed you are if you have a normal smile, and never suffer any form of facial paralysis.  We often forget to feel gratitude for this simple ability to make a uniquely beautiful expression.

In our next blog, we plan to bring you some wonderful secrets behind Dr. Orlando Cicilioni’s newest healthy skincare products.