Facial expressions are something that we often take for granted. The face is our platform to interact with the world, and our expressions are conveyed to others to help define us and interact with others. When a patient suffers from facial paralysis, he or she may lose complete ability to confidently interact with the world. Moreover, some patients may be perceived as being angry, upset, or aloof. Additionally, some patients lose their ability to close their eyes, speak clearly, breathe through their nose, or eat without drooling.
We know how daunting facial paralysis can be and how many patients have been told to keep waiting or to be satisfied with the way the results they have. Here, at UCLA, we use our expertise and capabiliy to perform advanced procedures to rehabilitate the paralyze face and bring improved functional and aesthetic results. The Facial Plastic and Reconstructive Surgical Team at UCLA works to restore meaningful and expressive movement while performing eyelid surgeries to help protect the health of the eye.
Causes of Facial Paralysis
There are many causes of facial paralysis. Some patients may have Bell's palsy, while others may develop paralysis after a traumatic fall, dog bite, or tumor removal surgery. Each patient must be approached in a personalized, individualized manner, assessing the timeline of events as well as the health of the facial nerve and facial muscles. In this way, the surgeon can determine which course of action will bring about maximal restoration of facial movement.
When a segment of the facial nerve is injured (dog bite, gunshot, stab injury) or perhaps excised purposefully during surgery while removing cancer, the nerve continuity can be restored. Our surgeons are able to perform delicate, microsurgery to suture the severed or damaged ends of nerves. If the ends do not touch and are not able to be secured together safely, a "cable graft" may be harvested to help bring the gap between the two ends.
This procedure connects the a portion of the hypoglossal or masseteric nerve, to a facial nerve to produce nerve growth of the facial muscles. This may be performed within the first two years of nerve injury to maintain facial tone, and possibly regain some function. These grafts may also serve as "babysitter" grafts until cross-facial grafting may be performed.
Typically, following the onset of facial paralysis, many patients will develop an inability to blink or close their eyes. Additionally, the lower eyelid may become "saggy", causing both eye dryness as well as pooling of tears. Lower-lid tightening procedures and upper-lid weighting operations are used to treat eye conditions.
Here, at UCLA, we size our patients with the appropriate weights before the surgery and implant either platinum or gold weights under the skin of the upper lid. In conjunction with this, we may perform lateral lid adhesions or canthoplasty to allow the patient's eyelid to close passively with gravity and protect the cornea from dryness. We area able to perform these procedures in the operating room as well as in the clinic under local anesthesia. We perform endoscopic brow lifting and direct brow lifting to help prevent the brow from drooping as well as bringing increased symmetry and harmony to the facial appearance.
One effective way to help restore a smile to a patient and decrease drooling is to perform a Temporalis Tendon Transfer, or "T3". The temporalis muscle is a large, fan shaped muscle that covers each temple. The muscle coverges onto a tendon which then inserts onto a part of the jawbone. Using non-invasive techniques (scarless or small scar in the nasolabial fold), we can transfer this tendon to the corner of the paralyzed mouth. When the patient bites down or clenches, he or she can experience quite a meaningful smile and significant improvement in drooling as well as improvement in appearance at rest. This is an outpatient procedure, and patients go home the same day.
Sometimes, to achieve an even stronger smile, a small segment of muscle from the inner thigh called the gracilis can be gently removed with its artery, vein, and nerve. This muscle is transplanted to the face and attached to an artery, vein, and nerve in the face/neck through microvascular surgery. After a brief waiting period, the muscle can move and pull the lip and corners of the mouth, allowing the patient to have a meaningful smile. We sometimes even perform a cross face nerve graft, where we take a portion of the facial nerve from the the opposite, unparalyzed side of the face to plug into the gracilis muscle. This can provide additional spontaneity with smiling and laughing. Patients walk without issues the first day after surgery and typically go home just 3-4 days after the operation.
Facial paralysis can cause the facial muscles to atrophy or become significantly smaller. Additionally, if a patient has parotid surgery, there can be large changes in the volume, size, and shape of a patient's face. In these situations, we perform fat grafting, filler injections, or even free flap tissue transfers to improve the contour and help restore normal appearance.
Botox injections can be used to treat synkinesis and overactive movement by weakening specific muscles and thus restoring facial symmetry. Botox injections can be artfully performed in strategic manners in both the side that is paralyzed as well as the healthy, unparalyzed side to really achieve significant improvements in the way you talk, blink, smile, and appear in photographs. Botox injections are performed in the clinic, and they take just a few minutes to perform. There is no downtime!
Facial paralysis patients can benefit from additional procedures like a facelift, necklift, browlift, fat injection, upper and lower eyelid surgery (blepharoplasty), rhinoplasty, laser skin resurfacing, PRP injection, fillers, and chemical peels. All of these aesthetic procedures help to provide a more rejuvanted, symmetric appearance which will help to make you look healthier, more rejuvenated, and more symmetric. We want you to be your best self!
Our board certified Facial Plastic and Reconstructive Surgeons are here to help you.