Facial reanimation gives patients their smiles back

At six-foot-four and 250 pounds, Mark Price has always stood out in a crowd.

But he was not prepared for the kind of looks he got after a motorcycle accident damaged a nerve, leaving the right side of his face paralyzed. “People would look at me like I just jumped off a spaceship,” he said.

His right eye could only close with the help of a weight in his eyelid, and half of his mouth drooped. Normal expressions were out of the question – a smile looked like a snarl. But Price went back to work as a corporate safety manager anyway, where he said he heard the same question 20 times a day: “You had a stroke?”

“I went about life,” Price said. “My parents always taught us that what doesn’t kill you makes you stronger.”

But Price’s story doesn’t end there. His doctor in Myrtle Beach told him there was a doctor at MUSC Health who might be able to solve some of his paralysis problems: Samuel Oyer, M.D., a facial plastic and reconstructive surgeon specializing in facial reanimation.

Facial reanimation, sometimes called smile surgery, uses nerves and muscles from the face and other parts of the body to correct paralysis. It’s only available in a couple of dozen medical centers across the country. Oyer did his fellowship at one of them, Johns Hopkins Medicine, then returned to MUSC Health, where he’d done his residency.

“There’s a lot of need for it here,” Oyer said. “There’s no one else in the region. The big areas are Harvard and Johns Hopkins and the Beverly Hills area. They’re all regional referral centers. Trying to get it closer to home for people is the goal.”

Facial paralysis can be caused by a traumatic injury such as Price’s, but it is more commonly linked with Bell’s palsy, which affects about 40,000 Americans every year. It can also be caused by cancer and acoustic neuromas, which are tumors on the hearing and balance nerve. And some children are simply born with some facial paralysis.

Oyer said not everyone needs surgery. “The simplest thing is, you see people with Bell’s palsy and watch them for recovery. We give them some exercises to do at home looking in a mirror. No intervention other than counseling and exercises.”

The next step up is injectable treatments such as Botox to help with facial spasms, twitching or drooling, Oyer said. If that isn’t enough, surgery comes into play. Oyer works with fellow facial plastic surgeons Krishna Patel and Judith Skoner to get the best results for patients.

Price needed surgery. “Dr. Oyer has the skills and abilities and make you comfortable,” Price said. “He said, ‘Mr. Price, we’re going to make this happen.’”

Oyer made a small incision in front of Price’s ear to find and connect a chewing nerve to his facial nerve. “You cut those ends and sew them together under the microscope.”

Now, when Price clenches his teeth, he gets some movement in his face. Oyer said Price also had a brow lift to keep his eye from drooping.

It’s not a cure, Oyer said. But if the face is the mirror of the mind, as some say, Price’s face now better reflects what he thinks and feels. “People don’t even know me since the facial surgery,” Price said. “I got a facelift, basically. I can smile now. I can chew.”

Oyer will continue to work with his 55-year-old patient. “He still has some speech issues. I’ve put some filler in his lip to help with that. He’ll be a lifelong patient.”

Oyer wants other people suffering from facial paralysis to know there’s help out there. “A lot of people are going untreated. Normally, with Bell’s palsy, people say wait a year, it’ll get better. And when it doesn’t, people don’t know what else to do. A lot of the physicians who see them don’t know what else to do,” he said.

“Sometimes, parts of the face start working together. So when you smile, your eye closes, your mouth kind of scrunches up, your face feels really tight. There are lots of things we can do to help that, but we have to get the patients in the door and raise awareness about the fact that there are treatment options.”

That’s important, because the effects of paralysis aren’t just physical, he said. “A lot of times, unfortunately, people with paralysis don’t go out. They shut themselves in, because when they go out, people stare at them. They have trouble holding secretions in their mouths, so they may drool a bit.

“When they try to smile, it’s not perceived as a smile. It’s perceived as a negative emotion. Rates of depression and social isolation go up. It’s really devastating for some of these folks.”

Oyer said his biggest sense of accomplishment comes from hearing patients tell him they went out to eat in a restaurant. “That’s a huge thing. That’s how we know each other, by our faces. If you can restore that – it will never be like it used to be, but if you can get them to the point where people don’t notice when they go out - then I think that’s a big win for them to restore their social function.”

Price never let his paralysis affect his social function, but he still considers himself very lucky to live near Oyer and his team. “They’re light years ahead in medical technology,” Price said.