Surgical options

If you have not recovered from your facial palsy or you feel your recovery has been extremely poor, your facial muscles on the affected side will be flaccid (floppy) and droop.  In these situations, there are some surgical options available.  However, your suitability for any of the surgical options is something that needs to be discussed in detail with your consultant plastic surgeon and where possible your rehabilitation therapist.

Things to consider

  • Your age
  • The length of time you have had your facial palsy
  • The presentation of your facial palsy
  • The cause of your facial palsy
  • Any functional deficits you may be experiencing
  • Your general health and any underlying medical conditions
  • Risks vs benefits of surgery


All surgical procedures carry risks, for example:

  • Risk of anaesthetic
  • Bleeding and/or haematoma formation
  • Infection
  • Scarring
  • Poor outcome

Surgery is not a ‘cure-all’ alternative.   You should keep your expectations low as there is no surgical procedure that is going to make your face look and/or feel the way it did before your facial palsy.

Static Surgical Procedures

Static procedures are operations which address your facial asymmetry at rest only.  They tend to be low risk because the operation is shorter, the recovery is quicker and your stay in hospital shorter.  It involves lifting and supporting the facial muscles on the affected side (specifically the muscles which can correct the position of the mouth at rest).  This type of static surgery can also improve facial function, for example, reducing dribbling and improving eating and drinking.  They are less complicated than surgeries which try to help restore movement on the affected side.

Rejuvenation procedures are static procedures which may be indicated in situations when the facial muscles are flaccid and droop.  In people with an unrecovered facial palsy, the drooping can increase over time, as the muscles can continue to lengthen due to their weight.  Various procedures can help improve symmetry at rest including brow-lift, face-lift, mid-face lift, and/or fat grafting.

Dynamic Surgical Procedures

These procedures aim to reanimate the face on the affected side which means they aim to restore some facial movements.  There are many different types of surgery that help to restore facial movement.  Surgical options available to you may depend on your plastic surgeon’s preference and expertise.  Other factors may be the length of time you have had your facial palsy, the cause of your facial palsy, your age and general health.

Dynamic procedures are often complex, take longer to perform, require a longer stay in hospital and may involve a prolonged recovery.  This is because they involve transposing nerves and/or muscles which means surgery is extremely intricate and delicate to perform.

Eyelid Surgery

If you have a prolonged recovery or no recovery at all then there are several surgical options available to help the eye close for sleep and to improve your blink.  A tiny eyelid weight can be inserted into the upper eyelid to help it close.  This is usually a gold weight or a tiny platinum chain. If there are problems with the position of the lower eyelid then the lower eyelid can be lifted and secured in a more natural position.  This helps prevents the eye drying as it can improve eye closure, tear drainage and eye comfort.

Surgical procedures for severely synkinetic muscles

These procedures are relatively new and involve releasing synkinetic muscles by carefully inactivating the synkinetic nerve supply to muscles which inhibit the smile.

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