One of the things that people with full or partial facial paralysis will tell you is how much they miss their smile. I had the same reaction, and still do even though much of my face has movement again. It just isn’t the same – and that’s by factoring in parts that didn’t regain movement and Synkinesis (explained below). By going to facial therapy every few months for the past four years, I have learned some interesting things that are helpful. First and foremost – A smile is not just a smile.
Our Eyes – We smile with our eyes as much, or even more than our mouths. Technically, the twinkle in the eyes of someone who is genuinely happy is caused by tear layer being compressed with slightly squinted eyes, which causes more reflection in the thicker layer of fluid.
Our Cheeks – We smile with our cheeks. If you hold a paper in front of your mouth and smile at someone, they will know without seeing your lips if you are smiling or frowning.
Symmetry – Beauty according to the modeling world and scientists of natural selection perceive a symmetrical face to be ideal. However if you start to study faces, few are symmetrical. We love people in our lives regardless of their natural symmetry. We love actors in movies sometimes because of asymmetry — Harrison Ford being one example. Brian Williams is a news anchor with asymmetry. I, personally, watch NBC nightly news because of his wit mixed in with the drama of the day, not because of his symmetry or asymmetry.
So we’re asymmetrical. Okay. Acoustic Neuroma survivors even more so than we were prior to brain surgery. Some parts don’t move and some move wrong. That’s because of a couple things that I will explain in such simple English that doctors and therapists will groan (and be reminded that I’m not a doctor):
Nerve Healing – Nerves heal at the rate of about an inch a month. BUT WAIT, there’s more! What I didn’t get is that the nerve doesn’t just heal at the little section that was damaged, but from that point out to the end. Take me for example – my facial nerve was damaged at the time of surgery. Obviously that damage was inside my skull. The healing required for my mouth to start smiling again was about 6-7 inches. So, the corner of my mouth turned up at seven months, which was about right. Some nerve fibers way out at the end of several branches will just never get movement back. Because of the distance, the forehead almost never comes back, I have been told. (Some facial nerves are severed and never come back, for which there are surgeries available)
Synkinesis – I was told by one doctor that once the nerve heals, it heals. My face would just start moving again. What he didn’t mention was Synkinesis. When the nerve is damaged, that means that some fibers within the nerve were broken. If you can image a rope being frayed, and then (use your imagination) it becoming whole again, it is easy to see that not all fibers would heal to their previous partner. That is Synkinesis. The improper movement of the face due to improper healing. For instance, when I try to raise my right eyebrow, it just sits there. However, when I do certain other movements with my face, it lifts like a little soldier. Gee, where were you when I asked you to raise? When I drink through a straw or pucker, my eye closes or squints. Synkinesis is determined by the amount of damage compounded with the length of time a nerve is paralyzed.
Neuromuscular facial retraining – Once the face starts moving again, it becomes locked up because our brains were trying so hard for so long to move those muscles that as soon as they healed, they froze. So we often think that movement hasn’t returned when it has. Facial massage, focusing on painful knots that we feel, will loosen those muscles and make us more comfortable. Retraining, which I haven’t mastered, is possible by making tiny movements and stopping when it stops matching the movement on the normal side. With time, our brains can remember how to better move. (this should be done with a trained therapist)
There is no magic bullet, and no point when many of our faces will ever be normal again. However, if we understand the mechanics, we’ll understand what our bodies are doing. Knowledge is power.
My next post will be about Pictures and Facial Paralysis. . .