Facial Paralysis and Facial Reanimation
Damaged facial nerves or muscles can cause the loss of movement (paralysis) of one or both sides of the face. The paralysis can greatly limit the ability to show expression as well as cause functional difficulty in opening eyes, swallowing, breathing, or speaking. There are multiple causes for facial paralysis and multiple ways to help improve function and movement of the face.
Bell’s palsy, also known as idiopathic facial paralysis, is a condition characterized by sudden, temporary weakness or paralysis of the muscles on one side of the face. It occurs when the facial nerve, which controls the muscles of the face, becomes inflamed or swollen, resulting in facial drooping and other related symptoms. The exact cause of Bell’s palsy is not fully understood, but it is believed to be associated with viral infections, particularly the herpes simplex virus.
The symptoms of Bell’s palsy usually develop rapidly, reaching their peak within a couple of days. Common signs and symptoms include:
- Facial weakness or paralysis on one side of the face, which can cause difficulty in closing the eye, smiling, or making facial expressions.
- Drooping of the mouth or eyelid on the affected side.
- Loss of taste or altered taste sensation.
- Increased sensitivity to sound in one ear on the affected side.
- Pain or discomfort around the jaw or behind the ear on the affected side.
- In some cases, excessive tearing or drooling.
The severity of Bell’s palsy can vary from mild to complete facial paralysis. The condition typically improves on its own over time, with most people experiencing significant recovery within three to six months. However, in some cases, residual weakness or other long-term complications may persist.
The diagnosis of Bell’s palsy is typically made based on the characteristic symptoms and exclusion of other potential causes of facial paralysis. Medical evaluation may include a physical examination, neurological tests, and, in some cases, imaging studies or blood tests to rule out other underlying conditions.
Treatment for Bell’s palsy often involves supportive measures to promote healing and manage symptoms. This can include medications such as corticosteroids to reduce inflammation, antiviral drugs in some cases, and eye protection measures to prevent corneal damage due to impaired eye closure. Physical therapy exercises and other rehabilitation techniques may be recommended to improve facial muscle strength and coordination.Fortunately, most patients recover the movement of the face. However, a small portion of patients will have incomplete recovery or are left with involuntary spasms of the face called synkinesis.
You may be a good facial animation surgery candidate if you
- are generally healthy
- are a non-smoker
- wish to lift droopy eyebrows, tighten eyelids, restore your smile
- want to regain facial expression
- have unbalanced or asymmetrical facial structure
Botulinum toxin and neuromodulators
Dr. Seth helps treat synkinesis with botox delivered to the individual affected muscles of the face to help reduce facial spasm and bring greater balance to the face. To learn more about this, please schedule an appointment with Dr. Seth.
Facial Reanimation Surgery
Facial reanimation surgery is a surgical technique used to treat chronic facial paralysis and to restore meaningful and expressive movement to your face. A detailed consultation with Dr. Seth, combined with consideration of patient goals, will help inform which elements of the surgery are best suited for each patient.
There are a number of different types of procedures involved in facial animation surgery. The duration and location of your procedure will vary depending on the type of surgery you require. Some common techniques employed in Facial Reanimation Surgery include:
Direct Reanastomosis or Nerve Graft — In situations where the facial nerve is cut, such as in a trauma or surgery, the severed ends of damaged nerves are sewn together, either directly or using a piece of nerve from elsewhere as a connector
Eyelid Procedures — Small weights (made of gold or platinum) may be implanted under the skin of the upper eyelid to utilize gravity to help close the upper eyelid. For patients who have lower eyelid laxity, the lower eyelid can be tightened (lateral canthoplasty).
Temporalis Tendon Transfer (T3) — To restore movement of the nasolabial fold and lip, a muscle and tendon that is in the temple may be transferred from the jaw to the corner of the mouth. This helps to move the corner of the mouth when biting down.
12-7 or 5-7 Nerve Graft — To encourage nerve growth in the facial muscles, Dr. Seth may connect the hypoglossal nerve (a nerve leading to the tongue), to the facial nerve or one of its branches. Similarly, the nerve that controls the contraction of the masseter muscle can be transposed to the smile branch of the facial nerve to allow the mouth to smile when biting down, a commonly aligned motion.
Contour Restoration — Facial paralysis can cause a change in the shape of a patient’s face. Either fat grafting from your abdomen or a microvascular free flap from the thigh can be used to add volume and contour to the area of the face that has less fullness after facial paralysis or injury. The tiny, microvascular blood vessels and nerves must be precisely reconnected using a microscope to restore blood flow to the tissue. Dr. Rahul Seth takes great care to create natural contours, match skin color, and strategically place incisions to minimize the appearance of scarring.
Botulinum Toxin (Botox) — Paralysis can cause muscles and nerves to stop functioning as intended. Conditions such as hypertonic (overactive) muscles, and synkinesis (a combination of voluntary and involuntary muscle movement) can be alleviated by the injection of Botox to weaken the affected muscles.
Recovery will vary depending upon the approach used and will be thoroughly discussed with you during consultation.
How To Get Started
If you’re interested in Facial Paralysis Treatment or want to learn more about your options with Dr. Rahul Seth, please request a consultation online or by phone at (925) 357-9050.
During your consultation, you will have time to discuss your goals and treatment options. During this process, you will get to know Dr. Seth and the Golden State Plastics team that will be with you every step of your journey. Once your consultation is complete and your unique treatment plan is created you will work with the Golden State Plastics team to schedule surgery. Once your surgery is scheduled, you will receive a pre-operative appointment to review your procedure, post-operative instructions, and expectations on your road to recovery.
Frequently Asked Questions
Facial paralysis can be caused by various factors, including Bell’s palsy, trauma or injury to the facial nerve, viral infections such as herpes zoster (shingles), tumors, autoimmune conditions like Guillain-Barré syndrome, and neurological disorders like stroke. Understanding the underlying cause is crucial for determining the appropriate treatment approach.
The treatment options for facial paralysis depend on the cause, severity, and duration of the condition. They may include medication, physical therapy exercises, surgical interventions, and complementary therapies. Medications like corticosteroids or antivirals may be prescribed to reduce inflammation or fight infections. Physical therapy can help improve muscle strength and control. Surgical interventions can range from nerve transpositions to nerve grafting or muscle transfers to restore facial movement.
Recovery time varies depending on the cause and extent of facial paralysis. In cases of Bell’s palsy, most individuals experience significant recovery within three to six months. However, recovery from other causes can take longer. Some people may achieve near-complete recovery, while others may have residual weakness or movement limitations.
The potential for full recovery depends on the cause, severity, and individual factors. In some cases, especially when the facial nerve is only temporarily affected, complete recovery is possible. However, in more severe or long-standing cases, full restoration of facial function may not be achievable. Treatment aims to optimize functional and cosmetic outcomes, but it is important to manage expectations and work closely with healthcare professionals to determine realistic goals.
Yes, physical therapy plays a crucial role in the management of facial paralysis. Physical therapists can provide exercises and techniques to strengthen the facial muscles, improve muscle control, and promote facial symmetry. Dr. Seth does not recommend electrical stimulation, but other biofeedback tools to enhance muscle retraining and functional recovery may be helpful.
Surgical interventions may be considered for facial paralysis depending on the specific case. Procedures can include nerve decompression, nerve grafting, muscle transfers, or other surgical techniques aimed at restoring facial movement and symmetry. The decision for surgery depends on the individual’s condition, goals, and assessment by a skilled surgeon specializing in facial nerve reconstruction.
Facial paralysis can have physical, functional, and emotional impacts on an individual’s well-being. It can affect facial expression, eye closure, speech, eating, and overall quality of life. Emotional and psychological support, counseling, and rehabilitation services may be beneficial in managing the emotional challenges associated with facial paralysis.