It is pretty normal that when a group of friends gather, they spend the first few minutes complimenting each other's outfits, relishing over new hair-dos or chatting about the latest happenings in their lives. For Cecilia Proby, a patient at Madigan Army Medical Center, whenever she met up with friends, she was hit with the same question every time.

"They always asked me, 'Are you tired? You look tired,'" said Proby, the spouse of Navy Lt. Cdr. Derwin Proby, the commanding officer of the Defense Logistics Agency in Portsmouth, New Hampshire.

But Proby, a relatively healthy and active woman, wasn't tired. She wasn't feeling exhausted or fatigued. In fact, as her lively personality indicates, she was ready to have a great time with her friends. Unfortunately for Proby, the expression on her face told a different story. As a result of facial nerve injuries after a car accident, the nerves on her right side of her face were less active than the ones on her left, making it appear as if one side was drooping. Her right eyebrow didn't raise, the outer corner of her right eye sagged and the right side of her neck was in spasm.

"I did look tired," she said. "They were right."

Proby is one of many patients seen by Maj. (Dr.) Marc Hohman, a board-certified facial plastic and microvascular surgeon at the Madigan Otolaryngology Head and Neck Surgery Clinic. Hohman specializes in facial palsy and reconstruction and believes that patients like Proby deserve to be comfortable and confident with their faces, and to feel and look normal.

Hohman, a Johns Hopkins University and Dartmouth Medical School graduate, has established a new team of Madigan doctors who provide specialty treatment for patients with facial palsy, a weakness or paralysis of the face, or disorders of the facial nerves. Hohman's team includes Lt. Col. (Dr.) James Crawford, an otolaryngologist and neurotologist who specializes in tumors of the skull base; Lt. Col. (Dr.) Wayne Harsha, an otolaryngologist, head and neck surgical oncologist and microvascular reconstructive surgeon who specializes in tumors of the face and neck; Lt. Col. (Dr.) Adam Buchanan, an ophthalmologist and oculofacial plastic surgeon who specializes in reconstructive surgery around the eye; Col. (Dr.) Kristofer Radcliffe, a neurologist and neurophysiologist who specializes in advanced nerve testing; and, Cathy Blank, a speech language pathologist who helps patients with facial movement disorders. Hohman, who leads the team as the primary surgeon, also spent two years at Harvard University concentrating on diagnosis and management of facial nerve disorders, to include medications, treatment and surgical procedures.

Facial palsy most commonly occurs with half of the face becoming weak or paralyzed all at once. According to Hohman, it is very rare that the entire face will weaken at the same time; however, there are instances where that may happen.

Some medical diagnoses that may result in facial paralysis are Bell's palsy (which is the most common), shingles, lime disease, tumors and other viruses. Short term effects of facial paralysis include droopy face, drooling, inadvertent biting of the lip or an asymmetrical smile, something Hohman says can make people feel very self-conscious. Typically, facial paralysis, as a result of the majority of these conditions, can be treated with specific medication, and, over time, may get better on its own. Hohman noted that most of his patients don't even require surgery.

Many active duty service members have benefitted from the care of Hohman and his team and were able to return to duty.

"One service member had a tumor removed from his head and experienced some facial paralysis," said Hohman. "It wasn't long before he was back to flying, and we fit treatments in with his busy schedule."

The most common question that Hohman is asked generally stems from his female patients, who wonder how their faces will look after surgery.

"I wouldn't offer surgery if the chance to make the patient look and feel better didn't outweigh the chance to make things worse," said Hohman. With patient-centered care at the core of his health care delivery, Hohman also indicated that there are some circumstances where he runs over allotted appointment times, causing other patients to wait a little longer.

"I take my time with patients," said Hohman, "and other patients understand that if we're over (the appointment time), it's because we are making sure everyone understands and is comfortable with the way ahead."

One of the biggest obstacles Hohman sees in the management of facial nerve paralysis is that the medical field is just not familiar with all of the different diagnoses and treatments available, an issue that Hohman hopes his team of doctors can help remedy. One of Hohman's goals is to establish a consultation network, where providers from around Army Medicine can seek input from his team on treatment options.

"It is very difficult for doctors to deal with (facial paralysis) primarily because most physicians haven't been trained to treat it," said Hohman. "The good thing, though, is that we specialize in it, and we're always open to consultations in order to find the best solution for patients." In October, Hohman will travel to William Beaumont Army Medical Center at Fort Bliss, Texas to consult with another Army surgeon, and to perform facial paralysis surgery on a VA patient.

Here at JBLM, Hohman has found the best solution for Cecilia Proby. A patient of Hohman's for the last two years, Proby said that she no longer looks tired as a result in the change of treatment plan that Hohman prescribed.

"He really knows his stuff," said Proby. "Now, my friends tell me I look different and that they really notice a difference in my face. I feel really great."

To be seen by Dr. Hohman and his team, Madigan patients must be referred to the Otolaryngology Head and Neck Surgery Clinic by their primary care provider. For more information, log on to www.mamc.amedd.army.mil.