Facial Paralysis

Weakness or paralysis of the face can occur from a variety of causes. Some individuals are born with facial paralysis, whereas others acquire facial weakness later in life. Some of the more common acquired causes include: Bell’s palsy, trauma to the temporal bone or face, infection, autoimmune disease, tumor, stroke or as a consequence from a prior surgery. Since the diagnosis responsible for the facial paralysis can vary, a thorough work-up should be completed by your doctor to understand the cause of the facial paralysis. Some patients have mild weakness of the face, others have focal areas of absent movement, while some are left with permanent paralysis of the entire face. Our team within the Facial Plastic and Reconstructive Surgery division at UC Davis is committed to providing individualized medical and surgical care for both adults and kids to improve facial function, aesthetics and overall quality of life. 

Bell’s palsy is the most common cause of facial paralysis and responsible for greater than half of all reported cases. The exact cause is unknown, but some episodes may be due to a viral infection that causes swelling in and around the facial nerve leading to paralysis. Treatment of Bell’s palsy can include steroids and sometimes anti-viral medicine. These medications aim to increase the chance of recovering normal facial function. Many patients experience either partial or full recovery following an episode of Bell’s palsy. However, approximately one-third of individuals remain with residual facial weakness or spasm. Our team at UC Davis is dedicated to improving the burden that the persistent weakness can cause.

Synkinesis is the medical term for abnormal or unwanted movement and spasm of the face. This may occur in patients who have recovered or partially recovered from Bell’s palsy. For example, some patients with facial paralysis have unintended closure of their eye, dimpling of their chin or contraction of their neck muscles when they smile. This can be very bothersome and contribute to an altered appearance of the face. Furthermore, these unwanted movements can lead to tightness and discomfort of the face. Botox® injections into the facial muscles offer one possible form of treatment for individuals with synkinesis to diminish these unwanted movements.

Furthermore, patients with facial weakness and paralysis may experience eyebrow drooping, inability to completely close the eye completely, nasal blockage and an asymmetric smile. After a complete evaluation and individualized discussion, treatments can be offered to address these problematic areas of the face. 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 a small eyelid weight under the skin can lead to improved facial symmetry and eye closure. Lip and smile asymmetry may improve with surgically lifting the skin and tissues around the mouth using a strip of the patient’s own tissue. Fascia is a common tissue used for facial lifting purposes and can be borrowed, with minimal side effects, from the patient’s own leg.

We have a passion for taking care of both adults and kids with all forms of facial weakness and paralysis. Our dedicated, multidisciplinary team provides specialty care with an emphasis on listening, patient education and personalized treatment plans that meet the patient’s priorities and help restore facial balance.

Work-up and Medical Management:

·         Testing to investigate the cause and prognosis of the facial paralysis may include some of the following:

o   Blood work

o   Computed tomography (CT scan)

o   Magnetic resonance imaging (MRI)

o   Electroneuronography (ENoG)

o   Electromyogram (EMG)

·         Medical treatment of new onset facial paralysis:

o   Steroids

o   Anti-viral medications

Medical and Surgical Treatments:

·         Botox® injections for synkinesis (abnormal movement of the face) or spasm

·         Optimizing eye moisturization 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   Eyelid taping

o   Eyelid weight placement

o   Eyelid tightening/partial closure

·         Surgical elevation of the forehead, facial skin and mouth that droop because of the facial paralysis:

o   Brow/forehead lift

o   Lifting of the face with fascia (borrowed from the patient’s own leg)

·         Nerve transfer for permanent facial paralysis that has occurred within approximately the past two years:

o   Masseteric-to-facial nerve transfer

o   Hypoglossal-to-facial nerve transfer

·         Muscle transfer surgeries for facial paralysis that occurred greater than 2 years ago:

o   Temporalis tendon transfer

o   Gracilis free tissue transfer