A new technique that restores facial movement with only a small incision and no major bone work will soon be bringing smiles back to sufferers of lower facial paralysis. The procedure, which involves transposing a facial tendon, was successfully employed in reanimating the faces of 17 patients.

“The primary goal of all facial reanimation protocols is to restore facial movement that is controlled, symmetrical and spontaneous,” writes Dr. Kofi D. Boahene and his colleagues, who published the report in the January/February issue of Archives of Facial Plastic Surgery. A previous method involved moving the temporalis tendon, which is attached to one of the muscles on the side of the head that allows us to chew, with an incision at the temple. This also required surgical dissection of the temporalis muscle.

The procedures were performed between 2006 and 2008 at the Johns Hopkins University School of Medicine in Baltimore. The single, small incision is made through a skin fold on the side of the nose or through the mouth, which is much less visible than an incision into the temple. No patients encountered any post-surgical complications and all achieved improved facial expression symmetry and enhanced voluntary motion.

After the facial surgery, directed physical therapy is necessary to retrain the patient’s facial muscles. “The visible movement gained from dynamic muscle transposition,” the authors write, “does not translate into a spontaneous controlled smile without intensive neuromuscular retraining.” The patient practices a “Mona Lisa” smile by raising the corners of the mouth, and then learns to smile by contracting the temporal muscle.

Over time, this becomes natural and spontaneous for the patient, so that the patient’s mind links smiling to the temporalis muscle rather than the muscles previously responsible. In order for this to be successful, patients must be highly motivated and dedicated to their physiotherapy, but the rewards may be well worth it.