Facial paralysis is an extremely difficult condition to be diagnosed with. This condition affects a multitude of people around the world, and is usually caused after damage has been suffered to facial nerves or the brain. Facial paralysis can only affect a portion of the face, or in extreme cases, can involve the entire face, prohibiting any movement at all from being made. To have partial or complete facial paralysis can have extreme psychological effects on the patient, as means of expression are taken away. At Kalos Facial Plastic Surgery, we have several different options we can use to help repair and correct facial paralysis which can be life changing for our patients. We will discuss various methods of facial “reanimation” that take into account the nature and location of nerve damage.
Depending on the unique nature of the patient’s facial paralysis, different options may be superior over others. If the facial paralysis is a relatively new condition for the patient and in the case that a nerve is in need of repair, it may be possible to perform this nerve repair a few weeks to months after the facial paralysis has been suffered. In this case, the surgeon would aim to repair the damaged nerve by attaching a different nerve between the two damaged ends. When this procedure is performed successfully, the patient will most likely experience a good outcome with restored facial movement. This procedure is dependent on the end nerves being in place, but when this is not the case, it may be possible for the surgeon to perform a cross facial nerve graft which involves using a branch of the opposite, healthy facial nerve to tunnel a nerve graft to the damaged side. This is performed in order to provide input to the damaged facial nerve and paralyzed muscles, which will ultimately help restore facial movement and reverse paralyzing effects.
In the case of facial paralysis involving the eyes, when there is no option for one of the direct repairs or nerve graft procedures (as is many times the case), then restoration of facial movement is best achieved by restoring eye function and facial tightening and lifting procedures. Facial paralysis involving the eyes aims to restore eye function and often includes placing a gold or platinum weight in the upper eyelid to assist with closure and tightening the lower eyelid to reduce tearing and allow for complete eye closure. Less commonly, some physicians may use a spring to assist with eye closure. Once eyelid function is restored the other facial asymmetries should be addressed either at the same procedure or with a separate surgery. With all surgeries involving the eyes, patients should also work regularly with an opthamologist.
The corner of the mouth and smile are often affected significantly with facial paralysis patients and can be addressed in several ways. Restoring symmetry of the mouth at rest is of primary importance. This can be accomplished with both “static” and “dynamic” reanimation procedures. The method chosen will of course depend on the nature of the paralysis but will ultimately aim to restore symmetry and movement.
Unfortunately there is no procedure to restore movement to the brow and consequently making the brow heights symmetric is the primary goal. This involves a brow lift procedure on the affected side to correct the asymmetry. Additionally, Botox may be used on the opposite, unaffected side to reduce movement and the ability of others to recognize differences with facial expressions. A facelift may also be used to elevate the cheek and correct the jowls on the affected side, further improving facial symmetry. If significant problems with drooling and difficulty controlling secretions and food exist, the lower lip may be tightened by removing a portion of the lip and tightening the lip muscle.
Facial paralysis is a complex problem with many different ways to address the issues, and there is not necessarily a single best procedure. Often the management requires the expertise of a neurotologist and a facial plastic surgeon for optimal results. The type of procedure selected for corrective facial paralysis surgery requires knowledge about the options available and the indications for their use. Consultation with a skilled facial plastic surgeon is important to achieving the best results and avoiding disappointing outcomes.
