Nate Jowett MD PhD

05/19/2025

Grateful for the invitation to return to my surgical alma mater , as a visiting professor to discuss facial reanimation with the next generation of reconstructive surgeons at .

The halls of Montreal General Hospital have been home to legends including Sir William Osler (a founder of Johns Hopkins Hospital and pioneer of modern medical training) and Dr. John McCrae (physician and poet author of "In Flanders Fields").

A huge congratulations to incoming Chief, Dr. Joshua Vorstenbosch, MD PhD !

10/19/2024

Cancer took away her joyful smile. Surgical brought it back.

This patient suffered permanent during chemotherapy and underwent two-stage free functional gracilis muscle transfer using novel surgical techniques to restore a spontaneous, upper dentition show smile.

In functional muscle transfer for reanimation in , prime considerations are vectors and neurotization source.

To restore joyful smile, two movement vectors are often required; one to pull the corner of the mouth and upper lip upwards and outwards, and a second vector to stabilize and slightly retract the lower lip to prevent it from drifting upwards and covering the upper teeth (see https://onlinelibrary.wiley.com/doi/10.1002/lary.29476 )

To control movement, two donor nerve sources are commonly used. The most reliable is a branch of the trigeminal motor nerve (“the masseteric nerve”), however this requires the patient to “bite down” to smile on the affected side. To reanimate spontaneous smile, redundant facial nerve branches controlling smile on the unaffected side may be re-routed using a nerve graft tunneled across the upper lip to drive synchronized contraction of the transferred muscle on the paretic side during empathic smile and laughter. Cross facial nerve grafting for smile reanimation carries a high failure rate owing to the limited number of axons which may be rerouted without weakening the healthy side face.

This patient underwent cutting edge “masseteric supercharged cross-facial nerve grafting” to power her smile, wherein contralateral facial and masseteric nerve branches are rerouted to the upper lip using a nerve graft. This technique carries potential to restore a strong spontaneous smile with added excursion achieved with bite.

This beautiful patient’s dual vector gracilis movements started just in time for her to smile spontaneously with her grandchildren at Christmas.

If you have questions about this technique, feel free to DM me and I’ll get back to you as soon as possible!

10/09/2024

Millimeters matter in .

Patients with facial following , , and benefit from conservative treatments including physical therapy, Botulinum toxin injections, and targeted facial muscle myectomies performed under local anesthesia to reduce facial tightness and improve facial symmetry.

These procedures are typically covered by health insurance.

10/06/2024

A key goal of facial is to restore a spontaneous that expresses joy (upper dentition show).

Treatment of including tumors of the gland can yield and facial soft tissue deformity.

Facial reanimation in patients with prior parotid cancer is challenging owing to the combined effects of prior surgery and radiation. The overlying skin flap is often atrophic, contracted, and poorly vascularized. Tissue planes are replete with scar tissue, and donor vessels are limited and tenuous.

Despite the challenges, given proper planning and ex*****on, chimeric multi-vector muscle flaps can be an excellent choice for rehabilitation of smile and facial contour in patients who have undergone radical and adjuvant .

Some pearls:
-The lingual artery and ranine veins are rarely resected as part of a neck dissection for advanced parotid cancer and often out of the radiation field, rendering them suitable as donor vessels in the vessel depleted neck. Retrograde flow from the facial / angular artery is also an excellent source to power free transferred muscle in this cohort of patients
-An adiopocuatneous paddle supplied by perforators coursing through the vascularized fascia between the gracilis and adductor longus muscles (and anterior segment of the gracilis muscle in some instances) can be harvested with functional muscle paddles based off a single vascular pedicle for recontouring of the cheek and provide additional skin to facilitate tensionless closure
-Fascia lata can be used to help re-create a gliding plane between the overlying skin/SMAS flap and the gracilis muscle
-Supercharged cross-facial nerve grafting is a good option for patients over 20 to balance power and spontaneity of reanimated smile

01/25/2024

06/08/2023

05/11/2023

Our lab is exploring the potential of to enhance outcomes in patients with .

Nerve fibers were treated with gene therapy to express a fluorescent red protein in proof-of-principle work recently presented at the 2023 Annual Meeting of the American Society for Peripheral Nerve (ASPN - ) by our talented research team

I encourage surgeons and researchers with an interest in facial reanimation to join ASPN and attend their exceptional annual meeting!

04/19/2023

Proud to be the parents of five first generation Americans 🇺🇸

02/13/2023

Many effective treatment options exist for patients with to restore facial symmetry and improve facial expression.

Treatment options differ depending on the type of :

The first type ('flaccid/weak facial palsy') occurs at the start of a facial nerve injury, such as , , Lyme Disease, or surgery.

The second type ('postparalytic facial palsy') is dominated by , and results from imperfect regeneration of facial nerve axons in the months following a facial nerve injury.

Some treatment options are time-sensitive and warrant urgent consultation with a surgeon specializing in facial reanimation. For example, patients who have not recovered any facial movement 3-4 months after onset of flaccid facial palsy should be seen by a facial nerve expert.

My 2018 article "A General Approach to Facial Palsy" summarizes these treatment options, and serves as a guide to inform data-driven decision making among clinicians treating patients with facial palsy.

02/12/2023

I'm thrilled to represent at the upcoming international Instructional Course for Reconstruction at Chang-Gung Memorial Hospital in Taiwan.

Chang-Gung is home to the world's most passionate, productive, and innovative Reconstructive Surgery team on the planet.

Looking forward to seeing old friends and meeting new ones for rigorous academic debate, and exchange of knowledge, techniques, and ideas to advance the field of

This will be my first visit to Taiwan, another "shining city upon a hill..." 🗽

Details here: https://www.2023fpr.com

02/07/2023

Our laboratory is laser focused 😎 on advancing 🧬 therapy for facial palsy and other cranial nerve deficits

http://www.surgicalphotonics.org/