Facial Nerve Paralysis

Beverly Hills Facial Plastic Surgery Center
Kimberly J. Lee, M.D.,
 Female Facial Plastic Surgery Specialist
Serving Beverly Hills, Los Angeles, San Francisco Bay Area and Worldwide

The facial nerve gives us the ability to show emotions by allowing us to move our eyebrows, nose, and lips. When damage to the facial nerve leads to partial or complete facial nerve paralysis, whether from Bell’s Palsy, birth, or surgery, it can be devastating both functionally and aesthetically. Using surgical techniques adapted from facial cosmetic surgery, Dr. Lee improves the function and appearance of the face resulting from facial nerve paralysis.

Facial Nerve Paralysis: Synkinesis and Muscle Tightness

One common complaint from patients is the tightness in the muscles that can result from facial nerve paralysis. This can be treated with Botox to alleviate the tightness, usually noted in the neck.  Also, synkinesis with narrowing of the eye opening while smiling is a subtle but common feature in patients with facial nerve paralysis.

Facial Nerve Paralysis: Facial Asymmetry

Aesthetically, the first thing that is noticeable in patients with facial nerve paralysis is the asymmetry between the two sides of the face.  Symmetry can be achieved using chemodenervating agents, such as Botox, to even out the facial asymmetry.  While Botox treatments are temporary, these treatments are effective in reducing the morbidity facial nerve paralysis experience.

For more permanent results, surgery can be performed to help patients with facial nerve paralysis achieve facial symmetry.  Using techniques modified from cosmetic surgery, the corner of the mouth to the same level as the unaffected side to achieve symmetry.  The drooping face is lifted and volume is restored to the midface.

Facial Nerve Paralysis: Brows

An aesthetic concern with facial nerve paralysis is brow asymmetry.  Descent of the paralyzed brow produces both functional and aesthetic concerns.  In addition to the loss of facial symmetry and impaired facial expression, the downward descent of the brow can contribute with any laxity in the upper eyelids to obstruct vision.  The brow position can be elevated to result in symmetry by using an endoscopic browlift along with a blepharoplasty if needed.  The techniques used to address facial nerve paralysis have been adapted from cosmetic surgery and help reposition the drooping brow while discretely camouflaging the incisions behind the hairline.

Facial Nerve Paralysis: Eyes

One of the most common problems resulting from facial nerve paralysis is the inability to properly close the eye and protect it from drying out and damage. Temporary treatments, such as eye drops, ointments, eyelid taping and patches are helpful; however, modern techniques place a gold or platinum eyelid weight to help the eyelid close with gravity.

Facial nerve paralysis can lead to sagging lower eyelids, which causes exposure of the delicate tissue of the eye.   This can be corrected by tightening the lower eyelid to help restore the natural position of the lower eyelid.

Narrowing of the eye opening while smiling is a subtle but common feature in patients with facial nerve paralysis and Botox is commonly used to address this synkinesis.

Facial Nerve Paralysis: Nose

Facial nerve paralysis can lead to collapse of the nasal passage resulting in difficulty with nasal breathing.  The nasal valve can be reconstructed to open up the nasal airway and restore airflow through the nose you can breathe easier.

Facial Nerve Paralysis: Smile

Restoration of an active smile and normal resting position of the cheeks and lips is one of the most difficult goals in addressing facial nerve paralysis with functional, cosmetic, and social significance. Facial nerve paralysis of the lower face leads to sagging and asymmetry of the lips leading to oral competence and drooling.   Eating and speech articulation are frequently impaired. The loss of facial symmetry and ability to communicate emotion with a smile can create far reaching cosmetic and social problems.

Facial Nerve Paralysis: A Customized Approach

The goal of restoring the smile, either dynamic or static, is to reestablish facial balance and harmony while simultaneously correcting the associated functional problems with facial nerve paralysis. Each surgical or non-surgical approach is tailored to the individual and is influenced by the cause and duration of the paralysis along with the condition of the facial nerve and muscles.   A large number of procedures are available to restore position, tone and motion to the cheeks and lips in patients with facial nerve paralysis. The technique best suited for the individual is carefully customized after detailed analysis.

Contact Beverly Hills Facial Plastic Surgery Center today for your personalized consultation at 310-882-5656.

Kimberly Lee

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