Kristyna Wentz-Graff

Following a stroke in 2015, Jarmilla "Jarm" Hawes (left) was left with one side of her face severely paralyzed. Myriam Loyo Li, M.D., at OHSU, was able to transfer nerves from one side of Hawes' face and tongue to the other, which eventually allowed Hawes to regain some movement and the ability to smile.

By Molly Harbarger | The Oregonian/OregonLive

First, Jarmilla “Jarm” Hawes felt a slight tremble of her upper lip. She had undergone a cutting edge surgery four months ago that reattached nerves from one side of her face to another and this was the only sign so far it had worked.

The tug on her lips months later bloomed into a smile -- the real kind, the kind that showed joy and heralded the return of her big, easy laugh.

Hawes, 56, suffered a hemorrhagic stroke in September 2015 that left her face paralyzed. She hardly laughed, she struggled to enunciate. She couldn’t smile.

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(Photo courtesy Dr. Myriam Loyo)

Before and after photos of Jarmilla "Jarm" Hawes, who had facial reanimation surgery.

Several doctors told her nothing could be done until she was referred to OHSU Hospital’s Dr. Miryiam Loyo Li, a facial plastic and reconstructive surgeon. Loyo Li is part of OHSU’s new Facial Nerve Center. The clinic is almost a year old and is focused on restoring more normal function and appearance to people with weakness or paralysis in their face, such as those who have suffered strokes, head and neck tumors or Bell’s palsy.

It is also the only place in Oregon, and one of few on the West Coast, that does facial reanimation surgery. Most places can offer Botox injections and face pulls that even out the look of a face and help with other aspects of living with facial paralysis.

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Kristyna Wentz-Graff

Jarmilla "Jarm" Hawes has undergone surgery and other treatments to regain function in her face following a 2015 stroke.

Facial reanimation surgery, though, is a relatively new technique in which hair-width nerves are disconnected one by one and reattached elsewhere. The nerves grow and strengthen on the new muscles and bring the face back to life.

In the four years since she was recruited to do this surgery at OHSU, Loyo Li has worked on 25 people’s facial paralysis and seen improvement in all of them. The degree of improvement varies. One patient will likely try another surgery after seeing little improvement, while others see outcomes similar to Hawes'.

OHSU researchers are currently studying the success rate for publication.

“For me, the wildest part is the smile and the ability to transmit those emotions,” Loyo Li said.

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Kristyna Wentz-Graff

Myriam Loyo Li is a facial plastic and reconstructive surgeon and assistant professor of medicine in the OHSU School of Medicine. She is one of five doctors in the newly created Facial Nerve Center.

Yet, many doctors and patients don’t know that facial reanimation is an option -- one that can be covered by most insurance.

Hawes’ story falls on the high end of success, largely because Loyo Li was able to use two muscles, rather than one.

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Kristyna Wentz-Graff

Jarmilla "Jarm" Hawes also has a weight in her eyelid that helps it close at night. She was at risk of losing the eye because of dryness.

Hawes’ stroke left the right side of her face motionless and droopy. Her nose was crooked, which made it hard to breathe. Her jaw worked, but her lips couldn’t form words, purse to sip beverages or pucker to kiss. She bounced among doctors who told her that there was no way to bring life back into her paralyzed face. She despaired and stopped leaving the house, except for doctor appointments.

“I really avoided looking at myself -- really looking,” Hawes said. “Everything was hard.”

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Kristyna Wentz-Graff

Dr. Myriam Loyo Li continues to work with Jarmilla "Jarm" Hawes to regain as much function in her face as possible after a 2015 stroke.

If she was in a restaurant, she wanted to sit in a place no one could see her eat or drink, since both were messy and difficult.

But she also kept asking each doctor if something could be done. She hated to see herself in the mirror and largely avoided it, and still carried a picture of herself before the stroke when she went to meet Loyo Li.

She handed it to Loyo and asked, “Will I ever look like this again?”

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Kristyna Wentz-Graff

Following a stroke in 2015, Jarmilla "Jarm" Hawes was left with one side of her face severely paralyzed. A surgeon at OHSU was able to transfer nerves from one side of Hawes' face and tongue to the other, which eventually allowed her to regain the ability to smile.

Loyo Li couldn’t promise that but suggested a surgery so new that Hawes had trouble researching it online. The surgery doesn’t guarantee results, but Hawes was willing to try.

“I had to do something,” Hawes said. “I just had to.”

In April 2016, Loyo Li operated on Hawes’ face and mobilized the facial nerve behind Hawes’ right ear to reach the nerves on the functional side of her face and tongue.

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Kristyna Wentz-Graff

Myriam Loyo Li, M.D. at OHSU worked with patient Jarmilla "Jarm" Hawes was left with one side of her face severely paralyzed following a stroke in 2015. Loyo Li was able to transfer nerves from one side of a patient's face and tongue to the other, which eventually allowed Hawes to regain the ability to smile.

The surgery takes months before results show. Hawes attended physical therapy and practiced exercises in the mirror -- the last place she wanted to be for so long.

Slowly, her smile came back. Her voice became clearer, and she started to leave the house for fun. She can drink from a plastic water bottle – an impossible task three years ago. She walks her dog and kayaks.

Hawes married her boyfriend, Ken May, recently, after dating for 15 years and appears in photos from that day.

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Kristyna Wentz-Graff

Jarmilla "Jarm" Hawes regained her smile after a 2015 stroke left her face paralyzed. Dr. Maryiam Loyo Li reanimated her face by connecting nerves from the droopy side to her tongue and a muscle on the functional side of her face.

She realized how many other pieces of herself she lost when those began to re-emerge. She feels wittier, and her laughter comes easier.

For more than a year, she has fine-tuned the control over her facial functions. Now, she has reached a plateau. She still slightly speaks out of the right side of her mouth and one eye looks slightly sleepier than the other.

Loyo Li tells her that those things might never be completely fixed. Her appearance is not exactly how she looks in that pre-stroke photo, but she can smile.

“Just to look in the mirror and not hate what you see,” Hawes said. “It’s improved my life.”

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Mark Graves

-- Molly Harbarger

mharbarger@oregonian.com

503-294-5923

@MollyHarbarger

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