Half Smiles are Cool™ for a little while… Surgery #14

A little background about my face…

One of the things that happened after my cyst fenestration surgery in January of 2018 was paralysis of my face. When I first came out of surgery, I had bilateral paralysis – both sides of my face was paralyzed.

I was pretty lucky “for the most part” in that the left side of my face went back to normal, BUT, the right side did not.  The paralysis affects my forehead, right eye (doesn’t close all the way), right ear area, cheek, inside of my mouth and my lips.

At first we thought it may be Bells Palsy (temporary paralysis of the face) which can happen due to major stress on your body. Bells Palsy usually corrects itself. Yes, any time you open up your skull for surgery it’s major stress. Especially with my track record of complications and bacterial meningitis.

So having half your face paralyzed may not seem like a big deal, but it is.

• My right eye doesn’t close all the way, so I have to put in drops a lot to ensure my eye doesn’t dry out (can cause damage to the cornea), wear glasses to protect it, and a face shield on my helmet facemask during football.
• I have issues eating – make noises sometimes since my right cheek and right side of my lips don’t work and I spontaneously smack.
• It’s very hard to shave – my face is not symmetrical so when I am trying to shave below my nose or get my chin and lower lip it’s very contorted since the muscles don’t keep my face tight.
• It’s difficult to talk and I sometimes slur my words because many words and pronunciation take muscles of your full face especially when you talk faster.

The worst part is in regards to my looks.  Your face is the first thing people see when they meet you and plays a huge role when you communicate. People don’t understand what’s up with my face and at times I feel that they look at me as a monster or having just a really messed up face which in today’s vain society means ugly – not to be harsh, but that’s the reality of it.

• Since I don’t have half of my facial expressions, many people may think of me as being angry – look angry all the time – but with paralysis, no expression is better than half expression.
•   When I smile, it’s only a half smile – but when you go through this you have to have a positive attitude – so “Half Smiles are Cool™”
•   Laughing is hard because laughing is a full-face expression and when only half your face works, your face is really contorted and with a half mouth laugh people look at me like “what the heck is wrong with your face.”

So that’s a little background on how I got my half smile and now on to what we will do to have my facial paralysis corrected.

I took my finals a bit early – St Norbert College and its Professors have been super helpful – and came home before Thanksgiving so I could have the first of several (hopefully only 2) facial surgeries to correct the paralysis on the right side of my face.

Time to stretch some nerves!

Since the normal nerve(s) that control my face was damaged, it doesn’t work, so we are going to use other nerves in my body to control the right side of my face and hopefully get it close to normal.

It took my mom a bit to find someone who could help, but by chance (actually nothing happens by chance only by faith), my former Pop Warner Coach Dave Razlowsky’s neurologist suggested Dr. Babak Azizzadeh  in Beverly Hills might be the Doctor that could help.  Dr. Azizzadeh specializes in facial reconstruction and is the best at what he does.

We met with him and his team in early summer before I started school, and the plan was to have surgery in early December.

My surgery was December 4, 2019 at Cedar Sinai hospital in Los Angeles.  Normally this type of surgery is out patient, but with my background and medical history of complications, we did it at the hospital and I had an overnight stay for just in case.

The surgery took about six hours.  Keep in mind this is a highly specialize microsurgery and my summary below is a very simple explanation.  Dr. Azizzadeh has written a whole book on just facial nerves.

The plan was to take working nerves (that I don’t use necessarily) from other areas of my body, attach them to the working nerves on the left side of my face, then route them to the nerves or muscles on the right side of my face so the left side of my face will control the right side of my face. As part of healing, at some point when I touch the left side of my face I’ll feel it on the right in the same spot – think about that!

The first part of the process took a nerve from my neck – a swallowing nerve that is an accessory nerve that I don’t need – and was attached to the muscles in the right side of my face. This nerve will stimulate the muscles in my face over the next several months and improve symmetry and lift the right side so it doesn’t sag. Keep in mind, the muscles on the right side of my face atrophied since January 2018 so the nerve stimulation will now allow them to come back but it takes time.  I can already tell there is some progress in my face and it has better symmetry when I shave and it’s not as contorted.

(WARNING SOME OF THE BELOW IMAGES ARE GRAPHIC) – I share the pictures because this is the reality of the journey, and if you, a family member or friend ever have to go through something like this you have a little insight.

The second part of the surgery took a 12” or longer nerve from my lower leg, and the team stretched it from the left side of my face over my lip below my nose and to the right side of my face.  This nerve will sit there and grow over the next nine months to a year and then Dr. Azzizadeh will go back in and attach it to the nerves and muscles in the right side of my face.  The goal here is to have the left side nerves in my face control spontaneous movements (smile and expressions) on the right side of my face.  If everything goes right, then I will have a symmetrical smile, facial expressions and who knows, I might even be able to whistle again.

So far so good, and what is most encouraging is that Dr. Azzizadeh is very optimistic.  Most doctors are not but he’s is super excited at the potential outcome.  This will be a long road, as nerves take a lot to work and heal.  I’ve seen some progress as my face is not as contorted when I shave and my face seems to not sag on the right side as much.  My next surgery is not going to be until next December when I am on break so it’s all about rest and healing for a bit.