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Getting Her Smile Back: Alex Marshall’s Facial Paralysis Story

Facial paralysis patient with mother

While out on her usual morning jog in Charlotte, NC, Alex Marshall was struck by a turning vehicle at a pedestrian detour. After that moment, and throughout the next year, her memories are hazy. The year was 2015. She was 28 years old, and her life came to a full stop.

When she regained consciousness in the ER, she was suffering from multiple injuries and broken bones — skull fractures, a shattered knee — as well as severe traumatic brain injury.

Alex later discovered she was also suffering from facial paralysis. Half of her face was unable to move like it used to. Devastatingly, she could no longer smile.

"If I was feeling gross or ugly, my confidence booster was my smile. I had a huge, big old smile! So to see that go away was really scary and heartbreaking," says Alex.

Coming Home to Heal from Facial Paralysis

Alex's doctors tended to most of her injuries. But they overlooked others. One of the skull fractures affected her middle ear, which damaged her facial nerve, leading to facial paralysis.

After moving to Charlottesville to be closer to her family, Alex began to seek care at UVA Health. To address her lingering facial paralysis, Alex's primary care doctor suggested she try therapy sessions with UVA Health physical therapist Helen Gatling-Austin. Therapy meant exercises to heal Alex's synkinesis. This involuntary twitching linked her eye and mouth muscles.

"We can't fix the facial nerve," explains Gatling-Austin. "It has to heal on its own. Our job as therapists is to retrain how the brain identifies the muscle and moves it."

She recalls Alex being up for the challenge. "I could tell she really wanted help for what was going on, and she was going to work hard to get better."

Reconstruction After Trauma

Accidents, injury, or cancer treatments may damage your face. Learn about reconstruction.

Finding Her Smile in Facial Paralysis

One of the hardest aspects of facial paralysis for any patient is the loss of their smile. Smiling is a key part of our daily communication.

Alex was thrilled when she found that an injection of Botox could help bring back her smile.

"Helen put me in touch with the ENT Clinic at UVA Health. And they actually gave me medical Botox. Never would've expected that! It's almost like putting a cast on one muscle to help relax it so you can retrain other muscles."

"Suddenly," Alex says, "I could focus on moving my muscles around my mouth to smile without having to have my eye closed. And as the Botox started wearing off, I realized that some of that hard work with Helen was staying."

Botox to Help Her Breathing

Throughout therapy, Alex discovered a facial muscle tightening that was restricting her breathing. She returned to the ENT clinic to consult with Sam Oyer, MD. Oyer saw a new opportunity to use Botox to relax those tight facial muscles.

Alex remembers Oyer's holistic approach. Oyer cared about all aspects of her condition and treatment since the accident. "He asked about what other doctors I was seeing. He asked all these questions to go into detail and find why I wasn't breathing properly," she remembers. "You could tell he really cares about his patients and makes you feel very comfortable and in good hands."

In Good Hands for the Road Ahead

Alex has used this opportunity to re-establish her roots in her hometown. While reconnecting with her family's fabric business, Alex channeled her talents into developing her own line of fabric designs.

With UVA Health's help and a refreshed outlook on life, Alex is able to see the road to recovery from facial paralysis.

"Now I'm at the point where we can finally address and fix these few last problems — things that got overlooked in the beginning. UVA is helping with that. Now I'm in good hands."

Watch Alex's story here.

View Transcript
Transcript:

ALEX MARSHALL: I lived uptown Charlotte. And there's a trail that goes out towards just outside of the town. I went on my usual route, it was about eight miles. And there wasn't a crosswalk, and the light was red, but I guess the turn lane had just turned, and somebody hit me. And it was really bad. I had a severe traumatic brain injury. I was unconscious, and broken bones, broken wrist. I was bleeding from my head. My skull was cracked open. There were a lot of things that got overlooked. A lot of it seemed better, but then I realized I still had some things bother me with my face. So that's when I came to UVA. My entire left side of my face was paralyzed. Ever since I was a little girl, my dad would always love and compliment my smile. And I had a dimple. And my favorite thing that if I was feeling gross or ugly, my confidence booster was my smile. I had a huge, big smile. So to see that go away was really scary and heartbreaking. There aren't very many face physical therapists in the country, and I'm very lucky because there's one in Charlottesville.

HELEN GATLING-AUSTIN, PT: Well, when we started working together, I could tell that she really wanted help for what was going on. And she was going to work hard to get better. From a therapy point of view, we can't fix the facial nerve. It has to heal on its own. So our job as therapists is to understand what's happening there, teach the patient how to stretch out the tight muscles, but also actually retrain how the brain identifies the muscle and moves it.

ALEX MARSHALL: After a lot of work with Helen, a couple years went by, and my face started tightening up. So I went back and Dr. Oyer was now there. He gave me the full face exam. There was a muscle that was tight here, and it was preventing me from breathing. So now he gives me a little bit of Botox here. It helps relax the muscle, and I can breathe better.

SAMUEL OYER, MD: Alex has been such a positive, optimistic patient of mine. And it's really amazing for me to see the journey that she has taken. There's not a lot of centers across the country that really offer the full spectrum of treatments. Botox alone won't do it. Surgery alone won't do it. It really takes a team. So here at UVA Health, we have that team in place. And people who are really passionate about treating people with facial nerve disorders.

ALEX MARSHALL: Going through something very traumatic, it's very important to have a good support team.

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