Facial Paralysis Treatment
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Your face is uniquely yours. Facial paralysis doesn’t just affect your appearance or your smile. It can also impact the way you talk, chew, and close your eyes. You may also experience spasms, twitching, or pain.
At UVA Health, we have a wide-ranging team of specialists who use facial reanimation surgery and other treatments to improve how your face looks, feels, and functions. We treat adults and children.
Facial Paralysis Expertise at UVA Health
Facial paralysis treatment is complex. You need a team with deep understanding of the anatomy of your face and ways to treat it. We’re here to find the right treatment and help you feel more confident. At UVA Health you’ll find:
- Facial paralysis treatment specialists: Our doctors are experts in facial paralysis treatment, including complex microsurgery. Your team includes facial nerve surgeons and specialists in eye surgery, head and neck surgery, microvascular surgery, neurosurgery, and neurology — all working together and coordinating your care.
- Skilled physical therapy: You may need physical therapy as part of your treatment plan. Our physical therapist is specially trained to help you improve function and reduce symptoms. Physical therapy also helps you recover after surgery.
- Care for your mental health needs: We also understand the emotional challenges that come with facial paralysis and offer mental health services if you need it.
- Facial paralysis research: We don’t just treat patients. We also research new advances and study how treatments affect a person’s well-being and overall outlook.
Facial Paralysis Treatment & Smile Surgery
Your treatment plan will depend on your symptoms. Some people benefit from injections or physical therapy alone. Others need facial reanimation surgery. Our surgery options include advanced microsurgical techniques.
How much we can restore movement in your face depends on:
- The cause of the paralysis
- Which parts of your face aren’t moving
- How long you’ve had facial paralysis
Facial paralysis treatments we offer include:
- Corneal neurotization
- Injections
- Muscle graft (gracilis)
- Nerve repair or graft
- Nerve transfer
- Selective neurectomy
- Static procedures, including brow lifts and eye lifts
- Temporalis tendon transfer
What Causes Facial Paralysis?
Some people are born with facial paralysis. Other causes include:
- Bell’s palsy
- Infections, including Lyme disease
- Injury
- Stroke
- Tumors
Partial or complete face paralysis may be a sign of a stroke or cancer. If you have sudden drooping or weakness in your face, call 911.
Have You Had Facial Paralysis for a Long Time?
Have you been told you’re out of options? We’ve successfully treated many people with long-term facial paralysis. We’ll work with you to:
- Understand your goals
- Create a treatment plan
- Connect you to physical therapy after surgery
Virtual Visits
We understand that travel takes time out of your day. Your appointment choices include virtual appointment options and virtual physical therapy.
Get a Second Opinion
Get peace of mind with an in-person or virtual second opinion. Our doctors will carefully review your options and make treatment recommendations.
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.
Facial reanimation surgery actually describes a group of procedures that are all directed towards improving facial paralysis. There's multiple reasons that people will develop facial paralysis. Some children are born with it, and they're never able to move one side of their face. Others get it because of trauma, or a tumor, or a surgery they may have undergone, and others get it because of an infection, or something like Bell's palsy which is actually one of the most common causes for facial paralysis. Facial reanimation really focuses on animating the face. It's exactly what it sounds like. And a lot of that focus is on bringing back a smile, improving the smile and also improving eye closure. The reanimation surgery is based on how much of the facial nerve is actually available. So for some people who have a temporary injury in their facial nerve, you can do a facial nerve graft, or a nerve transfer where you borrow a neighboring nerve and hook it into the facial nerve to try to get motion back to those facial muscles. Whenever we can, we try to restore motion to the person's own facial muscles. If the injury was longer ago, more than two years, then you can't get good motion by doing a nerve graft or a nerve transfer. You have to bring in new muscle to help give movement. So in those cases, we do a microsurgical approach where a leg muscle is actually transplanted into the face and it's hooked up to a nerve in the face to help create a smile when the patient smiles, either on the opposite side or maybe when they bite their teeth down with that nerve. Some of these surgeries are on the shorter end of the spectrum, where it's done as an outpatient procedure and a nerve transfer, a nerve graft can be done through a fairly limited incision. A patient is able to go home after the surgery is done. And they will see recovery of the nerve function in as short as four to six months. But it does take a while for that nerve to grow through and for the face to start working a bit again. Longer surgeries that involve muscle transfer typically require a hospital stay of about two to three days. This is to make sure that the muscle is healthy and that everything is healing well before going home. At UVA, we have doctors and providers who are specially trained in this and dedicate a lot of our time and efforts, both in research and in clinical care towards facial paralysis. So we have a whole team that can help a patient from start to finish, and we offer the full spectrum of treatment, from in-office Botox procedures, all the way up to microsurgical reconstruction.
Your Facial Paralysis Treatment Options
Corneal Neurotization
Corneal neurotization is eye surgery to restore function to a damaged cornea. We use a nerve from a different part of your face and connect it to your cornea. This specialized surgery is called a nerve graft. Find out more about corneal neurotization.
Injections: Botox & Filler
Botox decreases movement in some parts of your face. This can help if you have twitching or uneven movement. Botox injections make your face movement look more natural.
You may lose some face volume due to paralysis, causing you to look thinner on one side. Facial filler adds volume to your face and helps you look more symmetrical. Increased volume from filler may also help you keep food and liquids in your mouth.
Muscle Graft (Gracilis)
Nerve grafts and transfers don't work for long-term paralysis. Instead, a muscle graft may help restore your smile.
We transplant a small piece of thigh muscle (gracilis) to your face. This muscle replaces the action of paralyzed face muscle.
We connect the muscle graft to a nerve in your face. We may connect to a nerve on the affected side of your face or to one on the opposite side. In some cases, we connect it to both sides.
Some people need more than one surgery for a successful muscle graft. It takes time to heal and for muscle and nerve connections to grow. Physical therapy can help.
Nerve Repair or Grafts
During a nerve repair, we reconnect injured nerves to restore movement in your face. We may 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. We often recommend physical therapy after a nerve transfer to help you adjust to your new smile.
Selective Neurectomy
Selective neurectomy is a surgery that helps with Bell’s palsy or synkinesis (involuntary twitching and spasms). During this procedure, we sever the over-active nerves causing the movement. Selective neuroectomy helps your face movement look more natural and intentional. The procedure also reduces spasming or tightness in your face.
Static Procedures
Static procedures help return your facial symmetry. These procedures include brow lift, eyelid weight placement, lower lid lift, facial suspension, and nasal suspension. Static procedures can make it easier to:
- Close your eye
- Breath through your nose
- Eat without drooling
Temporalis Tendon Transfer
During a temporalis tendon transfer, we connect a tendon in your jaw to the corner of your mouth. This procedure creates a smile when you clench your jaw. You'll see results right away and don't need to wait for nerves to grow. You will need physical therapy after the procedure to practice natural-looking face movements.
Next Steps: Facial Reanimation Recovery
Your recovery and next steps depend on the type of treatment. Some procedures, like injections, are done in the office with few side effects. 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 after surgery. That’s because it takes time for your nerves to regrow and motion to return. We'll work closely with you during recovery to get you the best results possible.