Se­cret of a new smile

Ground­break­ing med­i­cal tech­nique giv­ing pa­tients power to grin again.

Herald on Sunday - - FRONT PAGE - By Lee Um­bers

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.”

Michael Prof­fitt and Staci Chap­pell can’t wait for their “per­fect” wed­ding.

Dr Moaveni

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