 Paralysis of the face has a significant negative impact on people's ability to function their appearance and how they interact with other people. I am Kalpesh Vakarya, Chief of Facial Plastic and Reconstructive Surgery here at the University of Maryland. Today, we're going to be drawing outside of the lines and describing a new and innovative facial reanimation procedure that can improve patients' smile and their facial symmetry. What makes this procedure extremely exciting and innovative is that actually we're going in and cutting nerves and cutting muscles in order to improve people's ability to smile and function. So the facial nerve comes out of the brainstem, snakes through the bone of the ear and comes out into the face. It enters the saliva gland and then it undergoes multiple branching and division. It ultimately integrates the muscles of facial expression. And these muscles are important in how we communicate with people around us. They give us the ability to frown and smile and laugh. Now patients with facial paralysis can have this because of multiple reasons. In general, a common cause of facial paralysis is Bell's palsy. This is thought to occur because of a viral infection that occurs at the nerve. Patients can also have facial paralysis because of other reasons, such as after facial trauma because of other infections or because of tumors on or around the facial nerve. It is important and critical to determine the cause of patients with facial paralysis and the type of paralysis that they have. The reason this is so important is because we direct treatment toward the reason they're having the paralysis and we also direct treatment toward the type of paralysis. Here at the University of Maryland, we take a multidisciplinary approach to patients with facial paralysis. We do combination therapies to maximize their outcomes. This combination includes physical therapy, medical management, and a variety of surgical options to improve their facial function. Now one of the new and innovative surgical options that exist is called this modified selective neorectomy. This is an exciting new procedure because in certain patients, the reason they have paralysis is because their facial function is limited because you have certain muscles such as the buccinator, the risorius, the ubiquularis auras, the depressor anguli, as well as the platysma that counteract one's ability to generate a meaningful smile. You have other muscles such as the zygomaticus major and minor, the elevators of the upper lip, and depressors of the lower lip that are incredibly important for a person to be able to generate a meaningful smile. Now through this innovative outpatient surgery, which we perform through a facelift type incision, we go in and find the small nerves within the face. We then use an electric nerve stimulator and we go ahead and stimulate the different nerve branches to determine which nerve branch goes to which muscle. What's really innovative here is that we're actually going to go cut something, so we're going to destroy something to actually make something better. We go in and we actually cut the nerve branches that are going to these muscles that we have found to be counterproductive. Additionally, we cut a portion of the platysma muscle to help some of this counterproductive downward pull on smile, and we also by doing this relieve some of the tension that people have in their face and neck. And that's what's exciting about this procedure because immediately after surgery you have a smile and that smile evolves and proves with time. We furthermore continue to treat patients like these with the combinational approach that we take at the University of Maryland.