Facial Reanimation for Facial Palsy and Paralysis

​The facial nerve is large nerve of the head that controls many important movements of your face such as smiling, frowning, chewing, furrowing your brow. This nerve may be damaged for many reasons such as trauma, surgery, stroke, brain growths, infection or a birth-related condition. This may result in permanent facial weakness (also known as facial palsy or facial paralysis), which results in noticeable drooping of the affected side of your face. You may also experience problems with speaking, blinking, swallowing saliva, eating or communicating through natural facial expressions.

Facial reanimation is a type of surgery that restores movement, function, and symmetry to your face to revitalise your ability to close your eyes, talk, chew, drink and smile.

From the time of facial nerve damage, the facial muscles will slowly lose their ability to contract over the months (atrophy). Once the muscles have completely atrophied, the options of surgical treatment to correct this problem become more limited. Thus, it is important to be reviewed by a facial reanimation specialist as early as possible to maximise your success of facial reanimation. 

The Procedure

Depending on the severity of your facial weakness and duration since the time of nerve damage, the following procedures may be recommended:

a) Nerve procedures
From the time of facial nerve damage, the facial muscles remain healthy for about 18 months before they completely shrink and lose their ability to function (atrophy). Thus, if no more than a year has passed since your facial paralysis began, it may be possible to restore the nerve stimulus to the facial muscles by transferring a nerve to that area. Examples include:

• Masseteric nerve transfer – one of the nerves responsible for chewing (the masseter nerve) is released and attached to one or more branches of the damaged facial nerve
• Cross-face nerve graft – a spare nerve is taken from the calf and used to connect the damaged facial nerve with one of the branches of the normal facial nerve on the unaffected side of the face

Recovery of movement after any nerve procedure takes months as nerve regrowth is very slow. It can take many months for muscle control to return on the paralysed side of the face.

b) Muscle transposition
Healthy muscle on the paralysed side can be rerouted to replace a function that has been lost after facial paralysis. Most commonly, one of the chewing muscles (temporalis muscle or masseter muscle) is used to restore smiling, as these muscles are powered by a nerve different from the facial nerve. This allows the person to smile on the paralysed side by clenching the jaw.

c) Muscle transfer
In this procedure, healthy muscle is taken with its nerve and blood supply from another area – commonly the thigh (gracilis muscle) or back (latissimus dorsi muscle) – and implanted into the paralysed side of the face. As nerve regrowth into the muscle is slow, it can take many months for muscle control to return on the paralysed side of the face.

d) “Static” procedures
These simpler procedures allow quick improvement in the symmetry of the face but do not restore facial movement. Examples include:

• Gold or platinum weight insertion into the upper eyelid – this helps with eyelid closure, protecting it from injury and preventing dry eyes
• Tightening of the lower eyelid – this helps with eyelid closure, protecting it from injury and preventing dry eyes
• Static sling surgery whereby a spare tendon or connective tissue is used to resuspend the drooping corner of the mouth – this improves facial symmetry, speech, and helps the mouth to keep food and drink inside more effectively
• Face-lift on the paralysed side (Face-lift -> hyperlink) – this tightens and lifts the skin and muscles, removing sagging skin to improve symmetry of the face

After the Surgery

The recovery process for reanimation procedures varies depending on which procedure is performed, whether you have more than one procedure, your age and health, and how long your nerves and muscles have been paralysed. Painkillers and antibiotics will be prescribed to control the pain and minimize the risk of infection. For more complex procedures, you will stay in hospital for a few days until you have recovered sufficiently for discharge.

Your surgeon will see you regularly in clinic afterwards to monitor your wound healing and recovery of facial function. If you have had a nerve or muscle procedure, facial nerve rehabilitation therapy after surgery is key to maximising the results of your procedure. A specialised facial physical therapist will review you regularly over the months and guide you through the necessary exercises in your ensuing months of recovery.

It may take one year or more to achieve maximum facial movement following facial reanimation surgery and rehabilitation therapy.

Understanding the Risks

As with any major surgery, facial reanimation carries risks such as:

• Adverse reaction to the anaesthesia
• Bleeding
• Hematoma (accumulation of blood under the skin)
• Seroma (an accumulation of fluid under the skin)
• Damage to underlying important structures
• Wound infection
• Poor wound healing or wound breakdown
• Poor scarring
• Lack of effect or undesirable result – such as continued eye exposure problems, difficulty with chewing, weak smile

You may need to undergo revision surgery to correct these problems. The subject of risks, as well as potential complications of surgery are best discussed on a personal basis between you and your plastic surgeon.