Facial Paralysis Surgery

Facial Paralysis can be caused by many different reasons.  Some people are born with one or both sides of the face not working, either because of trauma during delivery or because of a rare conditions such as Mobius Syndrome, Melkersson-Rosenthal Syndrome, and hemifacial macrosomia.  Facial paralysis can also be caused by an infection.   Doctors think that a virus (likely Herpes Simplex virus) in the facial nerve causes swelling and inflammation in Bell’s palsy and this causes the nerve to not function properly.  Other infections such as Varicella Zoster causes inflammation of the nerve in Ramsey-Hunt, and also Lyme disease, and severe middle ear infections (mastoiditis) can cause facial paralysis.   Trauma to the face or a fracture to the temporal bone (the skull bone behind the ear) can lead to facial paralysis.  Finally, tumors in the parotid gland, middle ear and cerebropontine angle can compress the nerve and cause it to not function.

If you have experienced weakness or paralysis on one side of your face, it is best to work with a doctor to find the cause.  It is very important to work with a medical professional because some causes can be treated with medicines such as antibiotics, antivirals or steroids, while others need surgery.

For patients who know the cause of their facial paralysis and have facial asymmetry, there are several surgeries that can be done to improve the appearance and function of the face.   There are many different options for surgery depending on how long the paralysis has been present, the severity of the asymmetry, age of the patient, and what the patient wants.  There are many options ranging from short procedures that can be done in the office to long surgeries that are done in two stages with months in between. 

The best way to find a treatment plan that works for you is to visit Dr. Rodman for a full consultation.  At your visit she will discuss your history, examine your facial movements,  and find an appropriate treatment plan based on your personal needs.  Some of the options available are listed below.

Eye Closure

  • Eyelid weight:  a small platinum chain may be placed under the skin of the eyelid to help with closure and protect the globe
  • Lateral tarsal strip: a short procedure to tighten the drooping lower eyelid

Brow Asymmetry

  • Browlift: raises one eyebrow on the affected side to match the normal side

Smile Restoration

  • Nerve Transfer
    • Cranial Nerve V→VII: one of the nerves that still works in the face is the nerve to the masseter, and this can be connected the cut end of the facial nerve, or to a new muscle transferred from the leg
    • Crossface nerve graft: several small branches of the facial nerve on the other (working) side of the face can be extended with a nerve graft and connected to the muscles on the non working side, or to a new muscle transferred from the leg

Dynamic Sling: The temporalis tendon, which usually helps close the jaw, can be moved to the corner of the mouth so that the affected side can be raised in a smile

Static Sling: A strip of tissue, either the patient’s own tissue or synthetic tissue, is sewn under the skin to life the corner of the mouth to match the other side

Botox: can be injected into any areas that spasm on the paralyzed side, to help that side from appearing twisted and contracted.  It can also be injected into some areas on the normal side (like the forehead) to weaken the muscles and make the two sides look more similar.

Refinement: Several other procedures can be done to treat the skin and improve the overall appearance of the face.  Some that are particularly helpful in facial paralysis are:

  • Midface lift: A facelift that focuses on the cheeks, bringing them higher and tightening excess skin
  • Neck lift: removes jowling and tightens neck skin
  • Skin treatment: can be done with fractionated CO2 laser, prescription creams and washes