Regaining symmetry--and normalcy--with facial plastic surgery
Date: December 11, 2009
Some face paralysis. Others, serious tumors both benign and malignant. And yet incredibly, when Kofi Boahene sits down to speak of facial surgery with many of his patients, the first concerns they often express aren’t about cures or amelioration of their afflictions.
“People always ask, How am I going to look?” says Boahene, who with fellow facial plastic and reconstructive surgeons Patrick Byrne and Lisa Ishii, is helping to define what society considers a “normal look” (see sidebar) and adjusting facial reanimation procedures to max out their physiological and cosmetic benefits. It’s not a question of vanity that drives patient’s fear, says Byrne, but their experiences, real or imagined, of being ostracized or stared at as they go about their lives.
The idea of reanimating the face—enervating nerves that, due to injury, disease or surgery, no longer function properly—is enormously complicated, says Byrne, noting the Division of Facial Plastic and Reconstructive Surgery handles some 100 facial reanimation cases per year, among the most in the nation. “There are 39 muscles that coordinate bilaterally to express the whole of human emotion,” says Byrne. “Trying to coax out of someone’s injured face the ability to integrate fairly well into social situations is difficult.”
Difficult, but not impossible. The goal for patients is to retain symmetry after surgery, because asymmetry is what draws unwanted attention. In fact, people shown altered photos of patients with facial paralysis—where the undamaged side of the face is replaced with a mirror image of the paralyzed side—often detect nothing wrong with the person’s features. To that end, the goal of facial reanimation becomes threefold: Use surgery to solve the underlying medical issue while generating as much nerve conductivity and fine muscle movement as possible, and combine that with physical therapy and training of the unaffected side of the face so that movements—smiles, frowns and the like—appear to match.
Some of the work is incredibly creative, drawing on the brain’s plasticity to overcome seemingly unconquerable dilemmas. Boahene recalls a case where one side of a young boy’s face had been paralyzed for two years because of a tumor. It was successfully removed through a tiny incision, and the nerve, though not functioning, was rerouted and reconnected to retain muscle tone.
Adults in similar situations learn how to move their tongues inside their mouths to create facial movement, but Boahene figured a 3-year-old couldn’t learn those things until he was older. Not long after, he received an emotional, grateful call from the boy’s father. “He said ‘My son can smile! My son can smile!’” recalls Boahene. “I was teary eyed. No joking. This kid figured how to wink, how to smile, how to move one side of his face, with no one teaching him. He has a nearly perfect smile.”
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