Facial Reanimation

Various issues can lead to facial nerve damage, which in turn hampers a person’s abilities to express emotions and function in a natural and effective manner. Patients seek facial reanimation surgery to restore their smile as well as improve their quality of life and general well-being.

Bell’s palsy and Ramsay Hunt syndrome are the most common causes of facial palsy. Both conditions are characterized by sudden facial weakness or paralysis without a discernible reason, typically attributed to viral inflammation affecting the facial nerve. Ramsay Hunt syndrome tends to have more severe symptoms, often accompanied by a rash around the ear, hearing loss, and dizziness. Other common causes include acoustic neuroma surgery, Moebius syndrome, trauma, stroke, congenital disorders, Lyme disease and parotid tumors or surgeries.

Your surgeon can employ a wide array of techniques to address the various effects of these conditions. These include cross-facial nerve grafts, gracilis muscle transfers, selective neurolysis, temporalis tendon transfer, facelifts to correct asymmetry, and other specialized procedures. Each approach is tailored to your specific needs to restore facial function and appearance.

Your surgeon may also recommend physiotherapy (neuromuscular retraining and soft tissue mobilization) and chemodenervation (Botox® or similar products) as a complementary procedure to facial reanimation. Because there are various types of facial paralysis, every treatment plan must be customized to the individual’s particular situation and anatomy.

There are only a few surgeons who have true expertise in facial reanimation, so choose your provider carefully. Make sure you discuss your surgeon’s expertise, track record and review their before-and-afters. Have a detailed discussion about your concerns, whether it is the inability to smile or asymmetry in the sides of your face, and be sure to ask about all attendant risks and benefits of each procedure.

Here is a more in-depth breakdown of various common issues related to facial paralysis and the techniques that physicians will typically apply in each case.

• Synkinesis, which involves involuntary muscle contractions, is often a symptom of Bell’s palsy, Ramsay Hunt syndrome or other facial nerve injuries such as trauma and acoustic neuroma. It occurs when nerve fibers regrow incorrectly after nerve damage, leading to spasms and poor smile function. Treatment includes physical therapy and botulinum toxin injections (Botox®) to reduce involuntary contractions. Facial reanimation procedures include selective neurolysis (a kind of “rewiring” of facial nerves) to help regain facial function.
• Complete facial paralysis involves the total loss of voluntary movement on one or both sides of the face. Management of complete facial paralysis depends on the length of time that has passed since the initial presentation and almost always requires surgery to improve smile function, tone, and symmetry.
• Moebius syndrome is a congenital condition characterized by facial paralysis and the inability to move the eyes laterally. It is caused by underdevelopment of the sixth and seventh cranial nerves and in most instances impacts both sides of the face.  Management is multidisciplinary, addressing speech, feeding, and eye care. Surgical options include gracilis muscle transfers, temporalis tendon transfer and nerve grafts to improve facial movement and expression. Orthodontic treatment and psychological support are often necessary.
• Eyelid paralysis can lead to dryness, corneal ulceration and potential blindness if not treated appropriately. Evaluation and ongoing management of the eyes under the supervision of an oculoplastic surgeon, ophthalmologist, or optometrist is crucial in the treatment of patients with this type of facial paralysis.

In addition to surgical options, there are many non-surgical techniques that can help improve facial function, symmetry, and overall aesthetics. These can be used alone or as a complement to surgical procedures.

Physical therapy — including facial exercises, neuromuscular retraining and soft tissue mobilization — can play a crucial role in promoting facial nerve rehabilitation. Botulinum toxin injections, such as Botox®, are used to selectively weaken overactive muscles and achieve a more balanced facial expression. Additionally, various cosmetic techniques, like dermal fillers, can be employed to address volume loss and restore a more natural appearance for individuals experiencing facial asymmetry due to nerve paralysis.

Note that electrical stimulation, such as neuromuscular electrical stimulation (NMES), should be avoided in most cases as recent evidence has shown it to result in worsened outcomes.

To develop a customized plan of care, consult all relevant experts and have in-depth discussions about the possible outcomes, risks and benefits of each procedure. With an individualized approach, many individuals regain aesthetics, as well as spontaneous and dynamic facial expressions.

Before you go

Facial reanimation surgery aims to address the underlying issues causing paralysis and restore function to the affected facial muscles.

During your consultation with a facial nerve expert, you can expect a thorough assessment of your facial function and detailed discussion of your medical history. The surgeon will examine the extent of facial nerve damage and explain potential treatment options. Be prepared to discuss your symptoms, their duration, and any previous treatments.

Key areas of discussion include the surgeon’s experience with facial reanimation, success rates, potential risks, and recovery times for each procedure. Review before-and-after photos of previous patients to understand realistic outcomes. Additionally, inquire about the surgeon’s recommended approach, possible complications, and post-operative care. Clear communication during this consultation is essential to ensure you are well-informed and confident about the procedure.

During the procedure

The specific procedures performed can vary depending on the cause of paralysis.

The duration of these surgeries varies widely based on the complexity of the case and the chosen surgical approach, ranging from a few hours to more extensive procedures lasting several hours. Some patients may require multiple procedures to accomplish the final desired outcome.

In many cases, facial palsy surgery is performed as an outpatient procedure, allowing patients to go home on the same day. However, more complex surgeries or those involving extensive reconstruction may require a hospital stay for monitoring and post-operative care.

Facial Reanimation Aftercare 

The timeline for visible results in facial nerve reanimation can vary significantly. You should discuss this matter in detail with your surgeon.