At the American Society of Plastic Surgeons (ASPS) and American Society of Maxillofacial Surgeons (ASMS) Plastic Surgery 2008 conference, which will be held from October 31 to November 5, 2008, in Chicago, plastic surgeons will reveal “facial reanimation” procedures that restore the ability to smile, ways to rejuvenate an aged smile, and enhance the often overlooked mouth region.

“A smile is a universal greeting and it’s often the starting point for all social interactions,” says Richard D’Amico, MD, ASPS president. “Unfortunately, some people cannot smile or are too self-conscious because of a defect, droopiness, or wrinkles around the mouth, or protruding gums. The inability to smile can be devastating to a person’s self-image.”

Facial reanimation treats two types of patients: those who are born without the ability to smile on one or both sides of their face and those who, due to traumatic accident, tumor or illness, like Bell’s palsy, can no longer smile. Many life-changing, successful “facial reanimation” procedures are being performed at the Facial Nerve Program at Duke University, which began with the arrival of ASPS Member Surgeon and “smile” course instructor Jeffrey Marcus, MD, 6 years ago. Marcus and his partner, Michael Zenn, MD, ASPS Member Surgeon and fellow “smile” course instructor, developed the multi-disciplinary program at Duke.

“The simple return of a smile creates a brief mutual connection. When we can’t do that, it can lead others to misinterpret our mood, intelligence or intentions,” says Marcus. “Facial reanimation surgery gives those who never could smile or those who have lost the ability, the power to communicate.”

Facial reanimation consists of one or two microsurgical procedures that involve connecting a specific nerve in the face to a transferred functional muscle taken from the leg. The nerve serves as an energy source while the muscle acts like a motor to create the motion needed to smile. For a patient who can’t smile on one side, a nerve graft (taken from the back of the calf) is connected to the nerve on the functional side of the face and extended to the paralyzed side. The nerve graft acts like an extension cord providing electrical currents to the paralyzed side. Then, 6 to 12 months later, after the nerve on the paralyzed side becomes “live,” the muscle is connected and its artery and vein are attached to vessels in the face. Typically, for a patient who can’t smile on both sides, the muscle is transferred and attached, in one procedure, to a nerve found on both sides of the face not usually used to smile, but is responsible for chewing.

In addition to reconstructing a smile, rejuvenating the aging or unattractive smile is a facial area that has not been commonly discussed.

“Restoring a smile’s motion is only the start of making a beautiful smile,” says Andrew Wexler MD, ASMS president and “smile” panelist. “The beautiful smile is a complex combination of lip and dental anatomy, which creates an aesthetic balance we view as beautiful.”

As with all plastic surgery, there are visual norms and factors, like symmetry, shape and texture that make up what is instinctively known as beautiful. Plastic surgeons have surgical and nonsurgical procedures and devices available to address areas of concern around the mouth.

“Dental and lip shape and color, tooth show, and lines of expression all must fall within our preconceived notions of beauty,” says Wexler. “To restore or rejuvenate the unattractive smile we must first understand and define those notions of beauty then apply our surgical skills to change the merely functional to the highly attractive. At one time the scalpel and sutures were the only tools we had. Today lasers, injectable fillers, fat, and Botox have opened a new frontier of possibilities.”

[ASPS, October 8, 2008]