Facial Paralysis Treatment

Some of the most important work our facial plastic surgeons perform is in facial reconstruction and the treatment of facial paralysis.

Patients who have had an illness, injury or accident deserve special care and healing. You’ve already likely endured significant physical or emotional challenges related to your health. Our goal is to repair any resulting damage to your face or neck to help you recover more fully. You will always be treated with respect and empathy.

Whether you experience temporary facial paralysis from Bell’s palsy or permanent nerve damage from trauma, experts at The Ohio State University Wexner Medical Center in Columbus, Ohio, can help restore your facial movement and your confidence.

What is facial paralysis?

Facial paralysis is the loss or weakness of voluntary movement in the muscles of your face. It happens when the facial nerve, which controls expressions like smiling, blinking and frowning, isn’t working properly. Depending on its cause, paralysis may affect one or both sides of your face and can range from mild weakness to complete loss of movement.

What causes facial paralysis?

Facial nerve paralysis occurs when the facial nerve is damaged, inflamed or compressed. This nerve travels from the brain stem to your facial muscles and is responsible for controlling your facial expressions.

Common causes of facial nerve paralysis include viral inflammation, infection, tumors that press on the nerve and traumatic injury.

In rare cases, facial paralysis can be present from birth when the nerves don’t form properly. It can also occur when a stroke interrupts the brain’s signal to the facial muscles. The cause of facial weakness or paralysis determines whether it’s temporary or permanent and guides the best treatment approach.

Types of facial nerve paralysis

Understanding the cause of facial paralysis is essential for choosing the right treatment. The main types include paralysis from inflammation or a viral infection, tumors, nerve injury, and complications that develop after surgery or a stroke.

The following are types of facial nerve paralysis:

Facial nerve paralysis caused by inflammation or viruses

Bell's palsy occurs with no known cause. While the resulting facial paralysis typically resolves, doctors treat it with corticosteroids, antiviral medications, eye drops and careful surveillance to prevent long-term damage.
Ramsay Hunt syndrome occurs when the varicella-zoster virus, which causes chickenpox, is reactivated. It can cause temporary facial paralysis, ear pain and a rash in the ear canal.
Lyme disease, transmitted by tick bites, can cause facial palsy on one or both sides.

Cancerous tumors affecting the facial nerve

A parotid tumor is a mass that grows in the neck’s salivary gland. Nerve damage can result from the cancer itself or from surgery to remove it.
Head and neck cancer can damage the facial nerve.
Facial tumors can develop in the soft tissues, bones or skin of the face and lead to weakness or paralysis.

Benign skull base tumors and lesions

Vestibular schwannoma, also known as acoustic neuroma, is a benign tumor on the balance and hearing nerve that can cause hearing loss, tinnitus or facial weakness.
Facial nerve schwannoma grows along the facial nerve and can lead to gradual paralysis or twitching.
Trigeminal schwannoma affects the nerve that provides facial sensation and may cause numbness, pain, or weakness in your chewing muscles.
Meningioma is a tumor of the protective layers of tissue surrounding the brain and spinal cord that can press on cranial nerves or brain tissue.

Facial nerve injury and movement disorders

Facial paresis is partial weakness or limited movement of facial muscles caused by injury, illness or surgical complications.
Synkinesis, also known as facial aberrant reinnervation syndrome, occurs when nerves are “mis-wired” due to facial nerve injury. This can cause involuntary muscle movements, such as an eye closing when you smile.
Chin dimpling, which is involuntary puckering or dimpling of the chin, is caused by a facial nerve injury.
Bilateral facial paralysis is weakness on both sides of the face, which is rare and often linked to systemic conditions such as Guillain-Barré syndrome.
Facial paralysis after a stroke results from damage to the part of the brain that controls facial movement.
Postsurgical facial nerve injury is facial weakness or paralysis that occurs after head, neck or parotid gland surgery.

Conditions inherited from birth

Congenital facial paralysis occurs when a baby’s facial nerve doesn’t develop or function properly, causing weakness or lack of movement on one or both sides of the face.
Moebius syndrome is a neurological disorder present from birth that causes facial paralysis, such as the inability to smile, frown or move the eyes from side to side.

Weak facial muscles and eye problems

Paralytic lagophthalmos refers to incomplete eyelid closure resulting from facial paralysis.
Lower lid ectropion occurs when the eyelid turns outward, exposing the inner eyelid surface and making it prone to irritation. This is more common in older adults and can be exacerbated by facial paralysis.

We can repair tissues or facial movements damaged by injury, facial trauma or a medical condition. We use very intricate surgeries, as well as nonsurgical options.

Surgical treatment includes repairing nerves or muscles through delicate reconnection or grafting – taking nerves and muscles from other parts of the body to reinnervate or replace damaged facial muscles.

Treatment type depends on the location and severity of your paralysis or injury.

Nonsurgical treatments

Facial nerve therapy, a specialized form of physical therapy, can help you regain control and coordination of facial movements.
Botulinum toxin injections, like Botox®, are targeted treatments that temporarily relax overactive or misdirected muscles. This can improve facial symmetry and reduce tightness or twitching.
Corticosteroid medications, like prednisone, can reduce inflammation and swelling around the facial nerve, helping it function and heal.
Antiviral medications may help treat facial paralysis from a viral infection like the varicella-zoster virus.

Eye treatments

Weak eyelid muscles can make it difficult to blink or fully close the eye. Nonsurgical treatments such as artificial tears, ointments and protective eye patches keep the cornea moist and prevent injury.

Surgical eye treatments include:

A platinum eyelid weight helps the upper eyelid close more easily with gravity.
Lower lid tightening procedures reposition or support the lower eyelid, reducing tearing and protecting the eye surface.
Brow lift surgery can restore symmetry, improve vision if the eyebrow has drooped and enhance facial balance.

Nerve and muscle transfer surgeries

When the facial nerve is irreparably damaged, surgeons may connect it to a nearby functioning nerve to reanimate facial muscles.
Cross-face nerve graft uses nerve tissue from your leg to link the healthy side of the face to the paralyzed side.
Masseteric-to-facial nerve transfer connects the facial nerve to the chewing (masseteric) nerve, helping with chewing and smiling.
Hypoglossal-to-facial nerve transfer uses a branch of the tongue nerve to reenergize facial muscles, improving tone and symmetry.
A segment of the gracilis muscle from the inner thigh or a small strip of strong connective tissue from the thigh (fascia lata) can be transplanted to the face to restore movement.

Treatment for synkinesis

Synkinesis occurs when facial nerve fibers heal in the wrong pathways after injury, leading to involuntary movements, such as the eye closing when you smile. Treatment focuses on retraining facial movement, calming overactive muscles and restoring facial balance.

Facial nerve therapy is specialized physical therapy that uses neuromuscular retraining, massage and stretching to help retrain coordinated facial movements.
Botox or other botulinum toxin injections can help relax overactive muscles, reduce tightness and improve facial symmetry. Effects last several months and can be repeated as needed.
DAO resection, and other myectomies, are surgical procedures to weaken or remove overactive muscles, such as the depressor anguli oris (DAO) at either side of the chin. This can improve smile symmetry and reduce downward pulling at the mouth’s corners.
When synkinesis doesn’t respond fully to therapy or Botox, selective denervation to cut small facial nerve branches can reduce tightness, twitching or involuntary eye closure, improving comfort and facial symmetry.

Why choose Ohio State for facial paralysis treatment?

At Ohio State, we understand how devastating it can be to lose your ability to smile and express yourself nonverbally through facial movements. Our facial plastic surgeons are among few physicians in the country qualified to perform intricate facial paralysis procedures.

Your case may require meticulous technique and careful planning, which is why it’s important to seek care from a board-certified expert who routinely performs these very intricate surgeries. Your Ohio State facial surgeon has not only completed additional, specialized training, but is also up-to-date through continuing education and research on the latest techniques.