Facial paralysis can be debilitating to a patient from a physical and emotional standpoint. Facial paralysis treatment is designed to improve a patient’s function while limiting the deformity associated with the paralysis itself. Whether the dysfunction is from infection, Bell’s palsy, previous trauma or surgery, an improvement can usually be made in one or more facial regions. A combination of surgical and non surgical procedures is typically the optimal approach to achieve these goals.
Treatment of the Upper Face
Loss of the brow muscle function results in a lowering of the affected eyebrow itself and asymmetry of expression when wrinkling or raising the brow. Treatment involves browlifting to raise the paralyzed brow combined with Botulinum toxin treatment of the non-paralyzed brow in order to improve symmetry with facial expression.
Paralysis of the orbicularis oculi muscle results in the inability to close the eye completely and an inability of the lower eyelid to adhere to the eyeball. This results in poor drainage of tears and can lead to chronic tearing, redness and irritation of the eye. Correction of the inadequate eye closure involves addition of a weight (traditionally made of gold, more recently platinum) beneath the skin of the upper eyelid to allow it to completely close when the eye-opening muscles are relaxed.
Correction of excessive tearing usually involves a surgery to shorten the lower eyelid and tighten it, thus restoring the lid adherence to the eyeball that the paralyzed muscle is unable to perform.
Treatment of the Lower Face
There are multiple procedures well-described in the medical literature and performed worldwide to treat paralysis of the lower face. The problems of lower lip symmetry, drooling from poor oral muscle tone, flattening of facial folds are all noted with lower facial paralysis. A combination of surgical and nonsurgical procedures is tailored to the individual deformity and dysfunction to maximize the patient’s function and appearance.
These procedures include:
- • Facial filler injections to achieve symmetry of facial folds and wrinkles caused by the opposite (active) facial muscles
- • Facelifting to improve the sagging, flattened appearance of the paralyzed side
- • Botulinum toxin treatment to opposite musculature to improve symmetry with expression
- • Lifting of the corner of the mouth via static or dynamic sling surgery, which helps support the corner of the mouth and potentially improve tone of the musculature in the affected side of the face
- • Other procedures, such as nerve grafting, gracilis free flap transfer, hypoglossal nerve jump grafting and cross-facial nerve grafting are also well-established techniques that Dr. Pero would be happy to discuss with you!