It's devastating when you can't have your emotions shared with your fellow human beings. And the face really is your mirror to the world.
If you can't smile, people will think you're angry, upset and unpleasant.And my poor patients that can't smile, they really struggle with this. It's a really fun, wonderful thing to be ableto offer people this potential treatment for it. It's not perfect. It's not going to be like a natural, normal smile, unfortunately, but we're getting there.
I would encourage everybody that may see this video to have hope and belief and advocate for yourselves.
But we're happy to help you here at UCSF.
What is the Gracilis Microneurovascular Flap?
The gracilis microneurovascular flap is an operation designed to have people smile again. In patients that have facial paralysis, the facial nerve leaves the skull under the earlobe and comes into the face. And patients that have long term, or have had congenital, they're born with facial paralysis, had trauma, that they developed nerve injury.
The nerve of smiling and then the muscles of smiling disappear completely. If those muscles aren't being used for over two years, it's a sad thing, but those muscles they say, I'm not getting any signal, and the muscle slowly but progressively atrophies away until it disappears forever, and you cannot rescue it.
In those circumstances, we need to bring in an entirely new muscle.You can take that muscle from a part of your thigh that you wouldn't miss, and we take that muscle and put it up in the face.
And usually when we smile, there's a fake smile, which people can just read across the room as being fake. There's a sincere smile: when you smile broadly, you show your teeth and then your eyes crinkle. And the crinkling of the eyes is the key thing that it's sincere, not trained or practiced smile.
So depending upon the patient, we take very careful videos and still photos, design the operation. We want to add the right amount of volume because the muscle is going to add volume to the cheek.
And then from that same incision that we have opened up, we will insert the muscle.
We sew it right along where the smile line is, from the inside, so there's no external cuts.
And then we sew the artery to an artery in the neck. Sew a vein to the vein in the neck, so the muscle becomes a living part of your face. It's almost like getting a kidney transplant or a liver transplant, where you're taking a piece of tissue and reconnecting it, only this is coming from your own body.
And then the key thing though is that you sew that nerve to a nerve in the cheek.
If we can, we'd love to sew it to the smile nerve. That way, when you smile with one side, you smile with the two sides. That's the ideal scenario. It's rarely possible. So we usually sew the nerve to the gracilis muscle to a chewing nerve in the cheek called the masseteric nerve. And the masseteric nerve is when you bite down and you feel that muscle tense in your cheek.
That's the masseter muscle. It's a little nerve that makes that muscle tense. If you think about it, nobody smiles with an open mouth. It looks fake and strange. Everyone smiles with their teeth clenched. That's a natural smile. So we've stolen the chewing nerve and rerouted it. We're doing a little electrical rerouting and we sew that nerve to this new gracilis muscle.
What is your expertise with this procedure?
The act of sewing those blood vessels together, you're talking about, two to three millimeters in size. So they're itty bitty little blood vessels. So to do the operation well, you have to be very experienced and capable of doing this fine microsurgery to reconnect the blood vessels and reconnect the nerves. I've done almost a thousand of these, what are called free tissue transfers, where I'm moving pieces of, of the different part of the body to rebuild the face. Not just the gracilis. I've rebuilt all parts of the face: noses and throats and tongues and jaws and scalps and brain coverage and ears and eyes.
Every week I do one or two of these transfers of tissue. And so that's what's key is then you get lots of repetitions and practice and experience doing the microsurgery.
Where can people learn more about your center?
UCSF specializes in, and has a large program for patients with facial nerve paralysis. We put together a website, facialnerve.ucsf.edu. And we have designed a website that gives you information about the different causes of facial nerve paralysis, the testing that's done classically to identify the cause.
Some of them reversible, some of them not. It helps us identify the timeline of when you might want to intervene and do an operation, or do therapy, or do neurotoxin injections to try to get balance. And then we have testimonials from patients. We have videos and photos of patients undergoing a variety of different treatments for facial paralysis.
Not just the gracilis microneurovascular transfer, but the whole gamut of what we do and offer for patients. And then if you're interested and want more information, we'd recommend that you schedule a consultation. And then in the consultation, we take both still photos and videos.
We can do simulated surgeries. We can show you simulated results and allows us to then create a library of your face. So that way, as you improve or as things change, we can track it along with our photos and videos.