Natalie was diagnosed with a brain tumor on the top of her brainstem so she’s had three very difficult brain surgeries so she’s had a very challenging young life. It also left her left side compromised mostly with the facial paralysis on her left side. – This surgery that we’re having this time is much much better than brain surgery. For her this is a huge undertaking because she always says you know I want people to know how I feel on the outside because I’m happy on the inside. I think that with this smile surgery it will just make me more confident in school and in different public places and just when people will see me I can smile the biggest smile that I can. And I can be more friendly and they’ll see the spirit and smile that I have on the outside. So our favorite thing is the fact that this is a, this is a happy surgery if there is such a thing. Bigger than any Christmas list for her is just to be able to have a smile so we’re very grateful for the opportunity to be here and have that possibility. Smile reanimation surgery as a whole is a very unique thing across the country. Facial paralysis in general is, is at best an undertreated problem for patients. There’s just not a lot of people out there that do much of anything for patients with facial paralysis so at best it’s under-treated. At worst, people will go untreated completely. This center here at the University of Iowa which I began when I got here almost two years ago is one of only a few comprehensive facial nerve centers in the country that specialize, that focus in and devote a significant amount of our resources, my time and my and my practice, to the treatment of patients with facial paralysis. So it’s very unique to Iowa absolutely. It’s very unique to the Midwest and really the West in general. The way that Natalie is undergoing this surgery is a two-stage procedure. So a year ago we harvested or brought out from her right leg sural nerve, which is a sensory nerve, and we use that nerve graft to sew to a branch of her working facial nerve that gives some smile on her right side and we sewed into that branch and then we tunneled underneath her lip and buried the tip of that nerve graft under the left side of her lip over here. And then what’s been a matter of waiting for that nerve to regenerate and be ready to accept another nerve graft which is going to be the second stage of the surgery. So in that surgery we take a part of her gracilis muscle which is from her inner thigh and we put it up into the face. We hook it up around the muscles of her lip and we sew the artery and vein in so that it can get blood flow in and blood flow out to keep the muscle alive. And we suture that nerve that goes to the muscle to the nerve graft that we put in last year. That gives this muscle, once it gets regenerated and the nerve starts working, an opportunity for this muscle to be powered by this native facial nerve. It gives her the opportunity to have an involuntary, natural, what we call mimetic smile, which is an automatic one that she doesn’t have to think about. And so it’ll take at least, it’ll take around six months for Natalie to start to see movement in that muscle. That’s a function of the nerve regeneration from the end of the nerve graft that we sewed to all the way into the muscle just takes time for those nerves regenerate. So about six months for her to probably start beginning to see the motion and then over the course of the next six to 12 months after that we may continue to see improvement and more and more movement. Wow! Seeing Natalie the first time coming out of surgery was just unbelievable. It was just so much fun to, you could noticeably see that there was a difference, obviously in her smile. She was definitely thrilled beyond her wildest dreams I think even. Natalie’s surgery yesterday went really well. I was very pleased with every aspect of it. We were able to do exactly as we planned to do using the gracilis muscle, transferring that up to the paralyzed side of her face. We easily found the tip of the nerve graft that we put in there before. We were able to put her smallish size vessels together and the blood flowing and now the muscles, very very nice and then we were able to sew the nerves together and everything really from start to finish went really nicely. Dr. Henstrom is awesome. He is so nice and I said that he’s more of an artist not a doctor because he wants to, you know, make me the best that I can be and I really like that about him. I think that with the smile I’ll be able to show my happiness that’s inside.