From Patient to Nurse: A Story Behind a Smile

Some years back, while looking at a few recently taken pictures of herself on her cell phone, Megan noticed her smile was uneven, with the right side not lifting as high as the left. The problem continued to worsen over the next few years, and Megan saw multiple specialists in Ohio to figure out what was wrong and how to regain her smile.

Full or partial paralysis on one side of the face can be caused by several conditions, among them Bell’s palsy, cancer, stroke, trauma and surgery. However, doctors were unable to identify the cause of Megan’s facial paralysis even after numerous scans and other diagnostic work up.

Ultimately, Megan’s facial paralysis did not improve despite multiple therapies. When this happens, surgery becomes the next option. Throughout this time, Megan continued to study and work towards a nursing degree.

Megan made an appointment to see Cyrus Rabbani, MD, Division Chief of Facial Plastic and Reconstructive Surgery and Director of UH Facial Nerve Disorders Treatment and Rehabilitation Center. To regain her smile function, Dr. Rabbani first performed a cross-facial nerve transfer on Megan. In this procedure, part of the facial nerve on the non-paralyzed, healthy side of the face is connected to a nerve harvested from the leg to reroute signals to the paralyzed side of the face.

Subsequently, Dr. Rabbani performed a microsurgical neurovascular muscle transfer procedure called a gracilis free flap. This procedure involves taking the long, thin gracilis muscle from the inner thigh and relocating it to the face. This is connected to the previously implanted cross face nerve graft for reinnervation. This muscle transfer aims to restore the smile and other facial movement in people with facial paralysis.

“My surgery and recovery went well,” Megan says. “I had a fair amount of facial swelling and bruising for a few weeks, but that’s normal for this type of surgery.”

Megan’s smile didn’t return overnight. Initial muscle movement in the treated side of the face typically does not appear until around three or four months after the procedure. Full results after a gracilis free flap evolve over the next six months to two years after the surgery.

Now, nearly two years after her last surgery, Megan’s smile has returned with a beaming glow. Just in time, too, as she got engaged in early 2025. With her wedding day set for September 2026, Megan is beyond excited to smile for the cameras.

The story does not end here. After Megan obtained her nursing degree, she began working at the UH Cleveland Medical Center post-anesthesia care unit, where she would often care for patients undergoing surgery by Dr. Rabbani. A nursing position in Dr. Rabbani’s outpatient surgery coordination team became available and Megan was a perfect fit. She joined Dr. Rabbani’s team in June of 2025. Megan continues to provide care for an assortment of patients in facial plastic surgery, including those undergoing the same and similar surgeries she had herself.

“It’s hard to have a medical condition that affects the appearance and movement of your face, because your face is what people see every day when you communicate with them, and our facial expressions are one of the main ways we express emotion,” says Megan. “When I care for facial paralysis patients as a nurse, I know exactly what they’re going through. Knowing firsthand what to expect when having these types of surgeries and what recovery is like allows me to connect with my patients in a way that puts them more at ease and makes my job that much more rewarding.”