Injection and Surgical Treatments

For facial paralysis that persists, patients may experience eyebrow drooping, inability to completely close the eye, nasal blockage and an asymmetric smile. After a complete evaluation and individualized discussion, treatments can be offered to address these potential areas of weakness. Non-surgical treatments, such as filler injection can offer simple improvements to a patient’s form and function. Minimally invasive surgical procedures, such as eyebrow elevation and placement of an eyelid weight can lead to improved facial symmetry and eye closure. Lip and smile asymmetry may improve with lifting or suspending areas around the mouth with a strip of tissue which is commonly a piece of fascia borrowed from the patient’s own leg through a small incision.

• Botox® injection for synkinesis (abnormal movement of the face) or spasm
  
  
• Filler injection to improve subtle facial asymmetries
  
  
• Assistance with maintaining eye hydration if the paralysis prevents complete closure of the eye – this can be accomplished with medications and/or surgical procedures:
  o Hydrating eye drops and lubricating ointment
  o Eye taping
  o Eyelid weight placement
  o Eyelid laxity tightening
  
  
• Surgical elevation of the forehead, facial skin and mouth that droop as a result of facial paralysis:
  o Brow/forehead lift
  o Static fascia sling of the face

Surgery for Restoration of Facial Motion

Dynamic surgical procedures are available in instances of severe and permanent facial paralysis with a goal to restore facial motion. If the paralysis began in the recent past (less than about two years ago), there are surgical options to transfer or reconnect nearby nerves to the facial nerve in an effort to restore movement of the face. The nerve responsible for chewing function (masseteric nerve) and the nerve that moves that tongue (hypoglossal nerve) can be surgically transferred to restore movement of the face. If the paralysis is more longstanding in duration (greater than two years or the patient was born with the paralysis), then new functional muscle needs to be repurposed or transferred into the face. The most common forms of these surgeries include the temporalis tendon transfer and gracilis free tissue transfer. 

• Nerve transfer for permanent paralysis that has occurred within the past two years:
  o Masseteric-to-facial nerve transfer
  o Hypoglossal-to-facial nerve transfer
  
  
• Muscle transfer for paralysis with an onset greater than 2 years ago:
  o Temporalis tendon transfer
  o Gracilis free tissue transfer