Facial Paralysis Surgery Before & After Photos

Facial paralysis can be due to trauma, cancer, or congenital reasons.

It can affect just some regions of the face, like the eyebrow or around the eyes. Or, it can affect the entire side of the face.

This results in:

– forehead paralysis with eyebrow droop

– eye closure problems leading to dry eyes and potentially corneal scarring and blindness

– loss of smile and facial symmetry important for communication and social cues

– nasal collapse and problems breathing

In this case, a free tissue transfer was done. A gracilis muscle from the leg was transplanted to his face. The blood vessels were connected to the temporal vessels, and a branch of the nerve to the masseter muscle used as a source of power.

The upper eyelid has also had a gold weight placed to balance the loss of closure force of the orbicularis muscle, and tightening and supporting of the lower eyelid with a graft has helped to elevate the lower lid margin.

Listening to a person’s goals – like with most of what we do – is paramount for helping someone be satisfied and comfortable with the plan, execution, and results. Also important is the setting of expectations, discussing what is likely and what is possible with surgery.

There are always tradeoffs. A more open eye when awake, can lead to more risk of exposure of the eye while asleep, for example. Every procedure also has risks, and the high likelihood of needing future surgeries as the paralyzed side does not age the same as the unaffected side.

This lovely woman had long-standing facial asymmetry after a stroke. She desired improvement of her symmetry in a single procedure.

We discussed the pros and cons of different options. We decided together on a combination of procedures, including:

1) sub-SMAS facelift on the right,
2) fascia graft from her leg to lift the corner of her mouth and help define her nasolabial fold,
3) fascia graft and fat graft to add volume to her cheek,
4) suture brow lift through two small incisions in her scalp.

We are both thrilled with her smooth recovery and boost in confidence.

Facial paralysis after an infection, trauma, or cancer, can be very difficult for a number of reasons.

Sometimes the initial asymmetry is fairly distressing, and then it worsens over time as facial aging continues asymmetrically.

One option for facial reanimation or symmetry is a dynamic procedure – free flap reconstruction with a functional muscle transplanted and connected to a local nerve to power the muscle.

At other times, a static procedure can be helpful, with less downtime and risks.

Here, a static sling using tensor fascia lata helped to lift the corner of the mouth. Additional focus was placed on elevating the redundant, ptotic vermilion on that side.

Other work was done to break up tight scar bands making turning of the head difficult and painful.

She is seen here at 1 month post-op.