'Smile doctors' create, restore and enhance patients' smiles

Imagine not having the ability to return the smile of a loved one or being too embarrassed by your mouth's appearance to display a smile. At the American Society of Plastic Surgeons (ASPS) and American Society of Maxillofacial Surgeons (ASMS) Plastic Surgery 2008 conference, Oct. 31 – Nov. 5, in Chicago, plastic surgeons or "smile doctors" will reveal state-of-the-art "facial reanimation" procedures that give people, who previously were unable, the ability to smile. Additionally, ways to rejuvenate an aged smile and enhance the often overlooked mouth region will be discussed. "A smile is a universal greeting and it's often the starting point for all social interactions," said Richard D'Amico, MD, ASPS president. "Unfortunately, some people can not 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 people: 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, six years ago. Dr. 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," said Dr. 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. Six to twelve 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", said 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 non-surgical 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," said Dr. 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."

"Smile rejuvenation procedures use a team approach to take the patient's smile to the next level," said Seth Thaller, MD, ASMS past president and "smile" panel moderator. "Plastic surgeons can work in conjunction with dentists or orthodontists to give patients the sparkling, full and shapely smile they desire."

Source: American Society of Plastic Surgeons