SURGERY FOR FACIAL PALSY (FACIAL
REANIMATION)

Cosmetic surgery can be used to treat a variety of conditions, one of which is facial palsy. This can be described as paralysis of the muscles responsible for facial expressions. If you suffer from facial palsy, you may struggle to produce facial movements (such as smiling) on the affected side of your face and you may also notice some facial asymmetry.

In some cases, important functions such as eye closure can be hampered, leading to secondary corneal damage and visual impairment. The facial paralysis may present itself as total paralysis or incomplete paralysis, so treatment will depend on each individual and the facial movement they have available.

Other factors that will affect your treatment plan include your age, general health and the underlying cause of your facial palsy.

What causes facial palsy?

The most common thread of facial palsy is called Bell’s Palsy which is caused by a herpes viral infection. Facial palsy can also be discovered at birth as a congenital defect that affects one or both sides of the face – this is known as Moebius Syndrome.

Other causes of the condition include trauma to the facial nerve, damage or incomplete development of the facial nerve as well as certain types of localised infections or inflammation. Some surgery can also contribute towards facial palsy, for example if you have tumours within the cranial region removed (such as acoustic neuromas and parotid gland tumours).

What about Bell’s Palsy? What are the symptoms?

Affecting both men and women of all ages, this temporary condition tends to start suddenly and have no obvious causes, with the key symptoms often developing over a few hours or overnight. Symptoms include:

  • Weakness or paralysis of one side of the face
  • Eyebrows may sag
  • Eye closure is difficult
  • Dry or watery eyes
  • Mild earache or pain behind the ear
  • Drooping mouth (drinks can dribble out)
  • Speech may be difficult
  • Taste can be altered
  • Hearing can be sharp on the affected side

What else do I need to know about Bell’s Palsy?

Bell’s Palsy is thought to be caused by a herpes virus infection that affects the facial nerve. This same virus is the one that causes cold sores – it is said to lie dormant in the nerve root, causing swelling if it reactivates. Approximately 75 per cent of patients suffering from Bell’s Palsy will recover completely spontaneously, with many individuals also seeing great improvements within three to eight weeks. For others, however, it can take three to six months for the condition to get better.

What are the treatment options for Bell’s Palsy?

The treatment for this condition includes using artificial tears to keep the eye moist as well as an eye pad or tape at night to keep the eye closed during sleep. Oral steroids are also used to reduce the swelling of the nerve and prevent any further damage, particularly if the drugs are taken within three days of the symptoms starting. The steroids are normally taken for 10 days. Antivirals such as valaciclovir can be prescribed to combat the herpes virus, however, there is little evidence that these successfully help treat Bell’s Palsy. Facial exercises and physiotherapy can also be useful to aid recovery.

Around 15 per cent of patients will be left with a residual facial weakness, muscle tightness or facial spasms. Tightness and spasms can be treated using Botulinum injections, which help to balance facial movements. Residual facial weakness and any eye closure problems can be treated using a range of surgical procedures instead.

Treatment Option One: Dynamic Muscle Transfer

  • Suitable for: Young or middle-aged patients

This is a two-staged reanimation procedure using microsurgery, involving a cross facial nerve graft from the normal side of the face. A nerve graft is taken from the sural nerve, found in the leg. This is then joined to a branch of the facial nerve on the normal side of the face before being passed across to the affected side.

Over the course of three months, the nerve fibres will grow from the normal side of the face to the affected side – this can now be used as a nerve source for a free muscle flap. The muscle flap is normally made from muscle found in the chest or thigh area. This muscle flap can then be inserted into the affected side of the face after a further three months to reproduce facial movements.

To sum up the process, the nerve fibres from the normal side of the face have passed through the cross facial nerve graft and grown into the muscle flap on the affected side of the face. Over several months, the muscle flap will begin to develop movement on the affected side, meaning that you will be able to produce facial expressions simultaneously with the normal side of your face.

Treatment Option Two: Static Correction

  • Suitable for: Older or less medically fit patients who cannot have a dynamic muscle transfer reconstruction

In these cases, we will use less complex procedures to produce successful results. This would include treatments such as creating a fascial sling – made using tissue from the thigh – to correct facial appearance at rest. This style of procedure is often combined with eyelid surgery which helps to protect the eyes as well as brow lift and face lift operations, which work to correct the descent of facial tissues and improve your overall facial appearance.

Treatment Option Three: Eyelid Surgery

Facial palsy patients will often find that they will require corrective surgery to help restore normal eyelid function and protect the eye. This type of procedure will include inserting a gold weight into the upper eyelid, as well as treatments that act to support the lower lid, such as a tarsorraphy. These operations will allow full eye closure and also protect the cornea.

Suggested Extras: Brow Lift and Face Lift

There are a variety of techniques that can be used to correct brow positioning, which can often descend down the face on the affected side. Face lift procedures in particular may be utilised to correct the descent of any facial tissues as well as improve the overall facial appearance – this is common for older patients.

Do you have any more questions? Would you like to book a consultation? Get in touch with us today by calling 020 7118 6887.

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