Helping Sammy to smile again

As it’s facial palsy awareness week we wanted to share how our plastic surgeons are able to perform a pioneering surgical procedure called facial reanimation. It is a relatively new surgical approach to help manage facial palsy, based on early intervention and surgery which is less extensive than previous techniques. One of our patients, Sammy, shares her story, and how the procedure and ongoing support of our facial palsy team are helping her learn to smile again.

“I had brain surgery in 2019 to remove a pilocytic astrocytoma, a type of slow growing brain tumour affecting the central nervous system. I’d been diagnosed six years earlier when I was 18. Nobody wants to hear they need brain surgery but I’d done my research and the outcomes were positive.

Unfortunately, when I woke from the surgery I was told I’d suffered a stroke which left me with paralysis down my right side, including my face. I was in the 2% of people that have a stroke from this type of procedure. I also developed nystagmus and oscillopsia, a condition where your eyes move involuntarily and it feels like everything is moving. Prior to the surgery I’d always been independent but, although the tumour had gone, the stroke left me needing to relearn how to walk, how to feed myself, and unable to smile. I moved back home to start my rehabilitation journey.

Daily physiotherapy helped me to feel better in myself and then in 2020 my GP referred me to the team at QVH. I was supported by the facial palsy therapists who gave me exercises to help with my facial paralysis. It was Tamsin Gwynn my therapist who referred me to consultant Ruben Kannan to test the nerve activity in the right side of my face and to help guide future surgery. The results showed the nerves were dying so I was referred for facial reanimation surgery within a month.

We’d not long come out of the first lockdown when my surgery took place in the September. I couldn’t have any visitors so the nurses on the ward would sit with me – they were amazing. Having surgery has given me hope for the future.

I came to an appointment with Tamsin in February 2021 and she asked me to try and smile. I didn’t know if the right side of my face was responding, but it was, slowly. Spontaneity hasn’t kicked in yet when I smile, but looking at photos I can start to see my smile improving each time. The facial paralysis also affected my ability to blink and my eye to naturally lubricate, making it dry and quite sore. After being referred to the corneoplastics team I’ve had surgery to try and improve
how my eye functions too.

I’m doing much better now and regaining my independence – I’ve even been on a paddleboard! I’ve started my own business and want to write a book to inspire others. I’m focused on the person I’ve grown to be on the inside and the exciting new opportunities I’m faced with, as a result of this challenge.”

What is facial reanimation surgery?

Ruben Kannan, consultant plastic surgeon, explains:
“Facial reanimation surgery is used to try to restore voluntary movement to a person’s face. It uses a precision surgical technique called microsurgery to transfer very small nerves (less than 1mm diameter) or muscles from another part of the body, to restore facial expressions and function to patients. This is very important for emotional communication.

At QVH the team uses an advanced technique called super microsurgery which involves nerves and vessels up to 0.15mm and using incision techniques from inside the mouth for scar-less healing and quicker recovery. This is revolutionising patient reanimation surgery, with Sammy being the first recipient in the world of this particular technique. Preliminary results from patients since have been encouraging and it provides better results with minimal, albeit technically demanding, surgery. This is in line with QVH’s specialist legacy of maximising results with the least risk to patients.”