Facial Paralysis Treatment

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Bell’s palsy, injury, stroke, tumors, or infection can stop the nerves and muscles in your face from working. Or, you may have struggled to move one or both sides of your face since birth. Facial paralysis affects how you talk, chew, close your eyes, and smile.

Whatever the cause, facial paralysis has a big impact on your life, physically, emotionally, and socially. Facial reanimation procedures can treat your facial paralysis. We can help you regain the function, symmetry, and expression in your face.

Face paralysis, partial or complete, can be a sign of a stroke or cancer. If you have sudden drooping or weakness in your face, get emergency help right away.

    What If I’ve Had Facial Paralysis for a Long Time?

    Our facial reanimation team has successfully treated people with long-term facial paralysis. You may have had treatment before. A provider may have told you your paralysis won’t improve. Even so, our experts may still be able to help.

    We’ll work with you to:

    • Understand your goals
    • Create a treatment plan
    • Connect you to physical therapy after surgery

    Your care and recovery team may include eye doctors, neurologists, surgeons, physical therapists, and ENT specialists.

    We also offer virtual appointment options.

    Facial Reanimation Treatment

    Every case of facial paralysis is unique. Your face may droop on one side because of a previous stroke, injury, or surgery. Or you may have tightness or twitching that causes exaggerated movements all over.

    We perform reanimation surgery to return natural, symmetrical movement to your eyes and mouth. Even if your paralysis is only on one side, successful treatment evaluates your whole face to restore symmetry. Facial reanimation procedures include:

    How much we can restore movement in your face depends on:

    • The cause of your paralysis
    • Which exact parts of your face aren’t moving
    • How long you’ve been paralyzed

    Restoring Your Smile

    Facial Plastic and Reconstructive Surgeon Sam Oyer, MD, describes how the facial paralysis treatment at UVA can bring a face back to life. View facial paralysis transcript.

    Nerve Repair or Grafts

    During a nerve repair, we reconnect injured nerves to restore movement in your face. Sometimes, we'll use a small piece of nerve from another part of your body (called a graft) to make these connections. The graft usually comes from either your neck or leg.

    Nerve Transfer

    Similar to a nerve graft, a nerve transfer connects healthy nerves to injured facial nerves. During nerve transfer, we move a nerve from a different part of your face to the affected area. We usually use the masseter nerve on the affected side (it controls chewing). We might need to combine this with nerve grafts. We do this when the existing nerves in the affected area are too damaged for a repair.

    We can only use nerve grafts and transfers if you’ve had facial paralysis for less than two years. With these treatments, you won't see results right away. It takes time for the nerve to regrow and work properly. Physical therapy after this surgery is helpful in training you to control your smile.

    Muscle Graft (Gracilis)

    In cases of long-term paralysis, nerve grafts and transfers don't work. When that happens, a muscle graft may help restore your smile.

    For a muscle graft, we transplant a small piece of the gracilis muscle to your face. It comes from your thigh. It replaces the action of paralyzed face muscle. 

    We connect the muscle graft to a nerve in your face. We either connect it to a nerve on the affected side of your face or to one on the opposite side. In some cases, it makes sense to connect it to both. Depending on your specific issues and goals, you may need more than one surgery for a successful muscle graft.

    It takes time for you to heal and connections to grow. Physical therapy can help you have a better outcome.

    Temporalis Tendon Transfer

    This procedure connects a tendon in your jaw to the corner of your mouth. This creates a smile when you clench your jaw. With this procedure, you'll see results immediately. You don't need to wait for nerves to grow. But you'll need some training and practice to get your face movement to look more natural.

    Injections: Botox & Filler

    We can use Botox to decrease movement in some parts of your face. This can help if you have twitching or uneven movement. It makes your overall face movement look more natural.

    You may lose some face volume in during your paralysis. It may look thinner on one side. Facial filler adds more volume to your face. Filler can make your face look more symmetrical. Increased volume can also help you hold food and liquids in your mouth.

    Physical Therapy

    Our physical therapist specializes in facial retraining after paralysis. Along with other treatments, physical therapy helps get the way your face moves to look normal and natural.

    Selective Neurectomy

    Selective neurectomy is a surgery that helps with Bell’s palsy or synkinesis (involuntary twitching and spasms). A neurectomy cuts nerves in your face that cause unwanted, involuntary movement. It helps your face movement look more natural and intentional. It also reduces spasming or tightness in your face.

    Static Procedures

    Static procedures, like brow lift, eyelid weight placement, lower lid lift, facial suspension, or nasal suspension, don't return movement to your face. Instead, they help return your facial symmetry. These can improve facial movements like:

    • Closing your eye
    • Breathing through your nose
    • Eating without drooling

    After Facial Reanimation

    Your recovery and next steps depend on the procedures used. Some procedures, like injections, can be done in the office. You might have a quick procedure and go home the same day. Longer procedures might require a stay in the hospital.

    You might not see results right away. It takes time for nerves to regrow and motion to return. We'll work closely with you during recovery to get you the best results we can.