There are many options now available that can help these patients regain function, as well as confidence regarding their appearance. People who are experiencing facial paralysis shouldn’t feel hopeless, because there are almost always options.
Being able to smile and express other emotions with our face is something that most of us take for granted. But for people who are unable to move facial muscles on one or both sides of their face as a result of nerve damage, the quality-of-life impact can be substantial. With advances in treatment, most patients with facial paralysis can benefit from one of the many approaches that now are available, according to UCLA facial plastic and reconstructive surgeon Irene Kim, MD.
Facial paralysis most often is caused by an infection or inflammation of the facial nerve, trauma to the head, a tumor in the head and neck or a stroke. It can occur suddenly or develop over time, and it can be short-term or long lasting. “In the past, many patients with facial paralysis were told that they were going to have to live with it. But that should no longer be the case,” says Dr. Kim, who helped establish a multidisciplinary program in facial reanimation at UCLA. “There are many options now available that can help these patients regain function, as well as confidence regarding their appearance.”
The inability to fully smile or otherwise express the emotions they feel on the inside is the biggest complaint Dr. Kim hears from patients with facial paralysis. But, she points out, there often are significant functional issues as well. “People might see an asymmetric face, but there also can exist deeper pain from struggles to do daily activities like brushing teeth or drinking water from a cup,” she says. When the muscles around the mouth are weakened, many patients have difficulty eating food without spilling or drooling. Some patients can’t close an eye, leading to dryness of the cornea, which can impair vision.
Facial nerve surgery is tailored to the individual patient, taking into account the cause of the paralysis, the timeline of events and the health of the facial nerve and muscles. In patients with Bell’s palsy, a form of paralysis that tends to affect one side of the face and is usually temporary, there is a tendency to treat medically and wait, since a majority of patients regain their facial function without intervention. But in other cases, Dr. Kim says, the UCLA team endeavors to be proactive with treatment to ensure that patients meet their facial-functioning potential.
“The traditional thinking has been to wait one-to-two years before we do anything, to see if there is some improvement,” Dr. Kim explains. “Most of us don’t think that way anymore. We don’t want to let the muscles atrophy.” When, for example, a patient has an acoustic neuroma — a benign growth on the acoustic nerve in the brain — removal of the tumor can weaken the facial nerve. These patients have early consultations with the facial plastic surgery team to plan outpatient nerve-transfer procedures.
Even if they aren’t candidates for facial reanimation surgery, patients can benefit from adjunct procedures to help the paralyzed eye blink or lift a droopy eyebrow. Aesthetic procedures such as a facelift, neck lift, brow lift, fat injection, eyelid surgery, rhinoplasty, laser skin resurfacing and fillers or chemical peels can help provide a healthier, more rejuvenated and more symmetric appearance. Botox therapy is offered for patients who, after recovering from their paralysis, develop synkinesis — abnormal involuntary facial movements that occur simultaneously with the voluntary movement of different facial muscles.
For some patients, acupuncture also can be effective in optimizing the recovery after treatment by promoting nerve regrowth and repair, says Malcolm B. Taw, MD, director of the UCLA Center for East-West Medicine in Westlake Village. Dr. Taw notes that acupuncture can prevent or reduce the symptoms of synkinesis, including the involuntary facial nerve muscle spasms. While acupuncture is typically offered after, rather than instead of, facial reanimation surgery, it can be a treatment option for patients in whom surgery isn’t immediately indicated, such as those showing early signs of Bell’s palsy. “Anything we can do to enhance the recovery of facial paralysis patients can have a huge impact on their quality of life,” Dr. Taw says.
“It is so rewarding to be able to help patients smile and feel better about themselves,” Dr. Kim adds. “People who are experiencing facial paralysis shouldn’t feel hopeless, because there are almost always options.”
For more information about facial reanimation procedures at UCLA, go to: www.uclahealth.org/facial-plastic-surgery/facial-paralysis
