Delicate surgery gives 19-year-old back her stolen smile

The surgery to remove Caitlin Cowen’s tumor fixed her brain but stole her smile.

Doctors successfully removed a tumor located deep within the Louisiana teen’s brain stem back in 2008, right before her senior year of high school. But during the procedure, brain regions that controlled the left side of Caitlin’s body and the right side of her face were damaged.

When the 17-year-old felt well enough to look at herself in the mirror, she quickly realized that she had no control over the right side of her mouth. No matter what she did, the corner just drooped. She couldn't smile.

“It was a big shocker,” Caitlin told TODAY.com. “I felt like I lost my whole face.”

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She also was left with double vision and a long struggle to learn to walk again. But the loss of her smile was especially hard for Caitlin, a quiet but social teen, now 19 and a sophomore at Nicholls State University in Thibodaux, La.

On bid day for her sorority, she cried because she thought she looked mad amid all the other young women who were beaming with smiles and laughter.

Caitlin’s dad, a physician who rehabs brain-injured patients, was sure there had to be a way to help his daughter. After combing through the medical literature and reaching out to experts, Todd Cowen found someone who might be able to help her: Dr. Tessa Hadlock, a Boston facial nerve surgeon who for years has been successfully bringing back smiles to kids who suffered partial facial paralysis either through a birth defect, from an accident, or from a procedure like Caitlin’s.

A description of Hadlock’s results in a series of 17 children was published today in the Archives of Facial Plastic Surgery. Hadlock reports that the surgery was successful in 15 out of 17 of her young patients. One of those 15 was Caitlin Cowen.

Courtesy of Cowen family

Caitlin Cowen, bottom right, with her high school graduating class.

It's a long, complicated operation and the result is only about one centimeter of facial movement. But that subtle ability to turn up the corner of the mouth can be life-changing.

Hadlock says that the ability to smile serves a critical social function you don't think about until it's gone.

During a two-part procedure in 2009, Hadlock transferred a muscle from Caitlin's inner thigh into her cheek, and attached it to nerves and blood vessels there. It took months for the nerves to sprout connections.

Caitlin starting seeing the first flickers of her new smile last May and ever since October, she's been able to flash a full smile whenever she feels like it.

She was queen of a Mardi Gras dance this March and beamed her smile the whole night.

The surgery is still fairly uncommon and there are just over a dozen centers around the country that do it regularly, says Dr. James P. Bradley, a professor of plastic surgery and chief of pediatric plastic surgery at the University of California, Los Angeles.

The payoff of a successful surgery can be huge, especially for kids who’ve got their whole lives ahead of them, Bradley says.

Caitlin knows all about the importance of a smile. She refused Christmas gifts this year, and instead asked her family to donate to an organization doing surgery for kids with cleft palates.

“I don’t think my smile is the same as it was, but I love it the way it is right now," she says. "I used to take it for granted. Now I appreciate it every day.”