Baby with facial paralysis gets new surgery to help her smile

  • Nicole Serna-Gonzalez, 11, became the first child to have new surgery to help her smile, according to the Cleveland Clinic.
  • Serna-Gonzalez was born with facial paralysis which left her unable to move the right side of her face.
  • Surgeons at the Cleveland Clinic have used a new approach to resuscitate her face, hoping she will have a symmetrical smile over time.

Nicole Serna-Gonzalez, an 11-year-old who was born unable to move the right side of her face, will be smiling broadly this holiday season after undergoing new facial resuscitation surgery last year. The Cleveland Clinic released details of the Serna-Gonzalez procedure on its website yesterday.

The Virginia native was born with unilateral congenital facial palsy, a condition that left the right side of her face unable to smile, blink, show emotion or even close one eye completely, according to the Cleveland Clinic.

Serna-Gonzalez’s parents told ABC that doctors initially said the condition would improve on its own, but later tests revealed the nerves in her face hadn’t developed when she was in utero, meaning the paralysis it was permanent.

In June 2021, Serna-Gonzalez became the first pediatric patient to undergo a complex 12-hour facial resuscitation operation to give her a symmetrical smile, according to the Cleveland Clinic.

Surgeon Patrick Byrne, president of the Cleveland Clinic’s Head and Neck Institute, led Serna-Gonzalez’s surgery, the first of its kind, called a gracilis tri-vector free tissue transfer.

Byrne and his team first harvested a nerve and muscle flap from the back of the leg. The surgeons then divided the leg muscle into three parts and placed them near the lip, corner of the mouth and near the right eye to allow for a full smile and eye movement. Surgeons rewired nerves from the functioning side of her face to the paralyzed side to allow for a natural, symmetrical smile.

Nicole Serna-Gonzalez

Surgeons harvested muscle and nerve tissue from Serna-Gonzalez’s leg to use for his facial resuscitation surgery.

Annie O’Neill Clinic/Cleveland



Serna-Gonzalez returned home four days after surgery and worked with physical therapists to learn how to use his newly built facial muscles. His parents told the Cleveland Clinic that they’ve noticed that Serna-Gonzalez’s ability to smile improves with each passing week.

“We know from other cases that the improvement we see at about one year will continue for at least another three to four years,” Byrne said in the release. “Especially at Nicole’s age, we [expect to] see the continued growth of the nerves and muscles of the face. The movements become more and more natural and symmetrical.”

Many people with facial paralysis have spoken out about their condition this year after Justin Bieber revealed that half of his face was paralyzed as a rare complication from a viral infection.

“As you can see, this eye isn’t blinking. I can’t smile on this side of my face. This nostril isn’t moving. So there’s complete paralysis on this side of my face,” Bieber said in a post on Instagram.

Although Bieber hopes his symptoms improve over time, surgeries like Serna-Gonzalez’s are needed to address the permanent paralysis, according to the Cleveland Clinic.

Byrne developed the three-muscle approach to allow eye movement while Serna-Gonzalez smiles. Surgeons typically perform the surgery only to move the mouth, excluding eye movement.

“It couldn’t have gone any smoother,” Byrne told the Cleveland Clinic. “Nicole was a rock star. She handled any stress related to the surgery incredibly well and she recovered very quickly.”

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