Facial Paralysis Treatment

Treating facial paralysis is among the most meaningful work our facial plastic surgeons do. When facial movement is lost or altered, it affects not only appearance, but communication, eye comfort, speech, eating and emotional expression.

If you’ve experienced facial paralysis due to illness, injury or surgery, you’ve likely faced physical, emotional and social challenges. We recognize that, and we take the responsibility of caring for you seriously. Whether you experience temporary facial paralysis from Bell’s palsy or permanent nerve damage from trauma, cancer or any other cause, 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. Injury to the facial nerve can also impact other facial functions, such as tearing from the eye.

What causes facial paralysis?

The facial nerve travels from the brain stem through the skull and face to control facial movement. Damage, inflammation or compression anywhere along this pathway can lead to facial weakness or paralysis.

Common causes of facial nerve paralysis include viral reactivation, infection, tumors compressing 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

These are common causes of facial nerve injury:

Facial nerve paralysis caused by inflammation or viruses

• Bell's palsy occurs when the herpes simplex virus is reactivated. While facial paralysis resolves for most people, some individuals will experience permanent changes in their facial movement. Initial treatment commonly involves corticosteroids, antiviral medications and eye protection (described below), to help reduce the risk of long-term weakness or nerve dysfunction.
• 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. Treatment is similar to that for Bell’s Palsy, though there is a slightly higher risk of incomplete or abnormal recovery.
• Lyme disease, transmitted by tick bites, can cause facial paralysis on one or both sides and is treated with antibiotics.

Cancerous tumors affecting the facial nerve

• A parotid tumor is a mass that grows in the parotid salivary gland in front of the ear. Nerve damage can result from the cancer itself or from surgery to remove it.
• Head and neck cancers that develop in other soft tissues, in bones or in the skin of the face (and their removal) can also lead to weakness or paralysis.

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.

What to expect at your visit

Your evaluation includes a detailed medical history, facial movement analysis and, when needed, imaging or additional testing. We focus on understanding how your facial paralysis affects your daily life – eye comfort, speech, eating and expression not just how it looks. Together, we develop a treatment plan tailored to your goals.

Facial paralysis treatment

Treatment for facial nerve disorders ranges from specialized therapy and injections to highly intricate reconstructive surgeries. We tailor care to the severity, cause and duration of your facial paralysis.

Surgical treatment includes repairing nerves or muscles, either 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 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 (lateral tarsal strip) reposition or support the lower eyelid, reducing tearing and protecting the eye surface.
• Brow lift surgery can restore symmetry and improve vision when the eyebrow has dropped with forehead weakness.

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. This is ideally performed within the first six to 12 months after nerve injury.
• Cross-face nerve grafting 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 branch of a chewing (masseteric) nerve to the facial nerve, helping to restore smiling.
• Hypoglossal-to-facial nerve transfer uses a branch of the tongue nerve to reenergize facial muscles, improving tone and symmetry.
• In cases of long-standing paralysis (more than one or two years), a segment of the gracilis muscle from the inner thigh can be transplanted to the face to restore movement.

Treatment for synkinesis

Synkinesis is a potential late effect of facial nerve injury that results in areas of tightness and involuntary motion in the face and neck. Although frustrating, it is treatable, and many patients see meaningful improvement with the right combination of therapy, injections and, in selected cases, surgery.

• Facial nerve therapy 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 tension and downward pulling at the mouth’s corners.
• When synkinesis doesn’t respond fully to therapy or Botox, selective denervation or neurolysis can be performed, where division of selective facial nerve branches can reduce tightness, twitching or involuntary eye closure.

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 have undergone specialized training focusing extensively on the treatment of facial paralysis and routinely perform these intricate procedures. We are also actively engaged in the national and international communities of facial nerve surgeons, ensuring that we remain up-to-date on the newest research and advances in the field.