Treatments & Procedures

Most patients with complete facial paralysis develop drooping of the eyebrow. This can obstruct vision and also create a very noticeable asymmetry. Browlifts can be a very effective help. There are a variety of browlift procedures, and they may be performed on just the paralyzed side, or, if desired, on both sides. More information upon request.

It is often not possible to restore a normal blink in facial paralysis. Thus the upper eyelid, while it opens normally (this is controlled not by the facial nerve but by another cranial nerve), cannot blink or even close completely. Placing an upper eyelid weight allows the eye to completely close. A true blink is not restored, but eye protection (particularly while sleeping) is improved.

The paralyzed lower eyelid may become displaced inferiorly (lid retraction) or turn away from the eye (ectropion). This can contribute to eye exposure problems and discomfort as well as excessive tearing. Tightening the tarsal strip can help elevate and/or tighten the lower eyelid to improve its position.

Static slings are a simple and safe strategy to suspend the sagging tissues of the face, slings can lift the corner of the mouth and drooping nose. A number of materials are used – either the patient's own tissue such as fascia lata (tissue from the leg) or commercially available skin substitutes such as acellular dermis.

Chemodenervation involves the use of Botox or Xeomin to constrain the activity of specific facial muscles. The goal of this procedure is to improve facial symmetry and it is performed for two reasons. First, to suppress synkinetic movement. These are the uncontrolled movements that often exist after a facial nerve injury, once the nerve has had a chance to heal. The other is to suppress movement on the other side of the face, in an attempt to make the face more symmetric. These injections are quick and easy to perform in clinic. The effects begin in a few days, and last typically for three to four months.

Dermal filler can be used in the corner of the mouth to add bulkiness to the side effected by paralysis. This added bulk helps improve speech as well as aids in the holding in of liquids.

Most patients with facial paralysis benefit from additional procedures to help make them look more youthful, symmetric, and help them feel more attractive. These include eyelid surgery, face and neck lift, and other procedures.

Most patients with facial paralysis benefit from rehabilitation. In rehab, patients are trained on strategies to compensate for reduced movement and exercises to maximize movement as well as massage, stretches, and relaxation techniques to keep the muscles light, loose, and mobile.

1. What is it: Bell’s Palsy is the most common cause of facial paralysis in the United States. With Bell’s Palsy, there is inflammation around the facial nerve and pressure from the inflammation prevents the nerve from being able to send its signal to the muscles which results in paralysis to the muscles of one side of the face.  
2. How does this happen: The cause of Bell’s Palsy is idiopathic but links have been made to specific viruses, depleted immune system, and stress.  
3. How is this treated: Upon diagnosis, patients are typically treated with steroids and antivirals and sent home being told that he/she is fine. 80% of individuals diagnosed with Bell’s Palsy will have full recovery over a period of weeks and months. In the remaining cases, recovery is incomplete and synkinesis can be present.  
4. How are we uniquely able to treat patients for this? We have worked with many individuals who have Bell’s Palsy and are uniquely positioned to help individuals understand Bell’s Palsy and provide treatment during this stage which may include eyelid management and rehabilitation for compensatory strategy training and exercises

1. What is it: Bell’s Palsy is the most common cause of facial paralysis in the United States. With Bell’s Palsy, most individuals experience full recovery but a small percentage will regain some function (tone returns to the face, and some movement) but are left with asymmetry of the facial movement and synkinesis. 
2. How does this happen: As the facial nerve recovers, ‘overfiring’ and unwanted connections between muscles can occur resulting in tension/tightness and/or unwanted movements.  
3. How is this treated:  The use of “chemodenervation” – the injection of Botox– can minimize synkinesis. The injection may also be used to reduce the movement on the other side of the face in order to improve symmetry. Patients are also often treated by our speech therapists to train individuals on massage, stretches, and strategies to reduce tension/tightness as well as retrain the nerve. 
4. How are we uniquely able to treat patients for this? Facial paralysis is unique to each patient and could involve multiple treatments; whether it be surgery, rehabilitation treatment, botox, filler, or a combination of these things. Our team approach allows us to deliver personalized attention and maximize outcomes.

1. What is it: Ramsay Hunt is a rare cluster of symptoms including facial paralysis, blistering, pain, vertigo, hearing loss or tinnitus, dry mouth, and dry eyes 
2. How does this happen: Ramsay Hunt occurs when the shingles virus attacks around the ear and facial nerve, resulting in inflammation. The inflammation prevents the nerve from being able to send its signal to the muscles which results in paralysis of the muscles on one side of the face.  
3. How is it treated: Upon diagnosis, patients are typically treated with steroids and antivirals.
4. How are we uniquely able to treat patients for this?  Our team provides aid in eye protection, assessing of facial movement, training in slow, controlled exercises, as well as muscle massages and stretches. We also provide training in compensatory strategies for speech and swallowing, as well as additional support options.