Secret of a new smile
Groundbreaking medical technique giving patients power to grin again.
Staci Chappell is looking forward to smiling on her wedding day thanks to a groundbreaking surgical technique.
Chappell was 18 when she noticed numbness in her right cheek. By her early 20s, she had lost movement on the right side of her face and her speech was affected.
“As a teenager I was fairly confident, I had a big group of friends. I went from going out in the weekends to staying home, I reduced my circle of friends right down.”
She was referred to plastic surgeon Dr Zachary Moaveni.
He and his specialist team at Middlemore Hospital are using a technique that sees nerves and muscles from the patient’s legs transplanted into their face.
It has shown remarkable results in returning movement to people suffering from facial paralysis caused by a variety of problems.
Patients as young as 5 are now having the smile surgery at the Facial Palsy Clinic, the first of its kind in the country. The surgery was proving life-changing, said Moaveni, whose team is now performing between two and four smile surgeries a year.
Seeing a patient regain their smile was “probably one of the most gratifying moments that I have as a surgeon. It's quite an incredible thrill. I remember one lady saying to me that she never, ever let anyone take any photos of her,” Moaveni said.
“And after her surgery she had her first photo for 10 or 15 years. And it was a really incredibly emotional moment.”
In the first part of the procedure, a nerve graft is taken from another part of the body, usually the leg, and plugged into the unaffected side of the face, and then run to the paralysed side.
The surgery takes about three hours.
Over three to six months, neurons grow across that nerve graft. The second operation, lasting 7-8 hours, is a functioning muscle transfer.
A “spare” muscle from elsewhere in the body is transferred along with its artery and vein to the face.
Blood vessels are joined with microsurgery and the muscle attached to the transplanted nerve graft.
Movement can return from three to six months later.
“It’s an amazing experience,” Moaveni said.
“I had patients [say] one day they’re brushing their teeth or looking in the mirror and suddenly they notice a bit of movement on the paralysed side of the face. It can be really dramatic.
“Over the next few months that movement improves and you get hopefully what’s a reasonably symmetrical smile.”
Significant time and planning was put into drawing contours of patients’ faces so the returned smile on the affected side of their face matched that on the other side.
“Each person’s smile is different,” said Moaveni. “So as a surgeon it is important to study the person’s smile and design the muscle transfer to get as good symmetry as possible.”
Chappell, who had her latest operation last year, said she cried when she first noticed she could smile again. “I was at home by myself, and burst into tears and rang my mum.”
The 27-year-old will have more operations but now has “the confidence to move on”. She got engaged to fiance Michael Proffitt this year.
“For years I had been dreaming of a white wedding but always worried about how I would look and was anxious about being the centre of attention,” Chappell said.
“Today I cannot wait for my big day, it is going to be perfect and so will the photos.”