Smile Reanimation
The language of plastic surgery has gained a new word. To the descriptions of plastic surgery goals (reconstruction, rejuvenation, revitalization) we can now add the term “reanimation.” It’s being used to describe a multidisciplinary approach that has developed with the goal of restoring a person’s smile.
The Concept
To a significant degree facial reanimation is reconstructive surgery: often performed on people who for one reason or another have not got the physical apparatus that forms the face into a smile. Some people are born with a physical defect that does not allow one side of the mouth or the other to form into a smile. Others have suffered nerve damage through trauma or illness such as Bell’s palsy, which has left them with nerve or muscle impairment that prevents them from smiling.
The concept of smile reanimation has been developed at the Duke University School of Medicine Facial Nerve Program. Dr. Jeffrey Marcus MD and his partner, Dr. Michael Zenn, MD refined surgical techniques with the goal of smile restoration in mind; today they are both practicing plastic surgeons and course instructors at Duke for the multidisciplinary program.
The Surgical Procedure
The maxillofacial surgery component consists of one or two microsurgical procedures that involve connecting a specific facial nerve to a functional muscle taken from the leg and placed within the lower facial area. For a person who cannot smile on one side, a healthy nerve is taken from the back of the calf and connected to the functioning nerve on the side of the face that can smile. This nerve is left to attach and grow for six to twelve months, allowing it to mature to full functionality. It is then attached to the grafted muscle which has its artery and vein attached grafted into facial blood sources.
For a person who cannot smile with either side of the mouth, the muscle is usually grafted in a single procedure and attached to functional nerves that are involved in the chewing motion but can also cause the newly grafted muscle to prompt a smile.
Rejuvenating Other Elements of the Smile
Enabling the mouth to pull its corners back is only one element of smile reanimation. The surgeons also look at issues caused by aging such as sagging areas and lines around the mouth. Other features to be addressed are lip profile along with dental and gum condition. Today’s cosmetic plastic surgeons have the use of Botox, fat grafts, facial fillers and laser tools to tone the look and color of the newly refurbished smile.
A cosmetic plastic surgeon engaged in a face reanimation may also consult an orthopedic surgeon, a dentist or a periodontist about specific improvements for the centerpiece of a smile: the teeth. Teeth can be whitened, capped and realigned in order to complete an attractive reanimated smile. Many people have conditioned themselves to not smile because they are embarrassed by the condition of their teeth.
Restoring confidence in that smile is part of the program for smile reanimation, and often that requires dental work to complete the reanimation process. These doctors consult while the surgical and cosmetic plan is developed in order to include dental or periodontal work at the right point. It is this collective approach to smile reanimation that truly makes it a multidisciplinary plastic surgery procedure.
