Facial Reanimation Surgery

Facial reanimation surgery may be recommended when you experience total or near-total loss of your ability to show facial expression. Facial paralysis may result from a birth-related condition such as Moebius Syndrome, a facial injury, or tumor surgery that involves the facial nerve. Either the facial nerve does not function properly, or facial muscles don’t develop properly or become lax and unable to perform.

Nature and Timing of Lost Nerve Function Determines Type of Surgery
Facial reanimation surgery can take two forms, depending on the nature and timing of the lost nerve function:

• Microsurgical muscle transfer can restore the ability to smile in people born without facial movement or with longstanding facial paralysis.
• Nerve transfers or grafts can restore facial muscle function in people who previously had facial movement but lost function following tumor surgery or trauma.

One or Two Stages
Facial reanimation is performed in one or two stages. When procedures are performed in two stages, they are often separated by a period of 9–12 months. Many factors are taken into consideration when determining the best approach, including your age, the cause of your facial paralysis, and whether it affects one side of your face (unilateral) or both (bilateral).  Your surgeon will explain this when recommending the process that will achieve the best possible results for you.

If You've Lost Facial Function You Had Before, Timing Is Important
The earlier you are seen, the better your outcome will be, as the newly transferred facial nerve may be able to regain control of your existing facial muscles before they become permanently paralyzed.

Other Procedures Don't Restore Facial Movement
Less sophisticated, more readily available procedures tighten or lift a drooping face to a more attractive position but don’t restore facial movement. Facial reanimation surgery restores or replaces lost facial movement. It may not create a perfectly symmetrical smile or completely restore a natural eyelid blink, but over time it will restore your ability to express your emotions through more natural facial movement.

Candidates for facial reanimation surgery have little to no smile movement, particularly smile or eye closure. A comprehensive consultation will help determine if facial reanimation is right for your condition. Before your visit, our doctors will want to know:

• What is the cause of your facial paralysis?
• When did your facial paralysis begin and how long have you had it?
• Have you had any prior surgery, procedures, or nonsurgical therapy?
• Can you provide results of past tests?

We also want to review photographs or video demonstrating your ability or inability to perform the following movements:

• Rest
• Eyebrow elevation
• Eye closure and tight eye closure
• Natural smile (with no teeth showing)
• Big smile (with teeth showing)
• Pucker

Maximum Facial Movement Results Take Time
It may take one year or more to see maximum facial movement following facial reanimation surgery and rehabilitation therapy.

Facial Reanimation Surgery Isn't for Everyone
For example, elderly patients or people with medical conditions that prevent them from undergoing lengthy surgeries may not be candidates for this complex process. In these cases, or when incomplete paralysis is present, we may recommend other surgical or nonsurgical methods to improve the balance of your facial appearance and help you regain some facial movement.

Born with Moebius Syndrome, Colton’s facial muscles were so weak that he was unable to show expression. Facial reanimation surgery at Duke Children’s Hospital brought a smile to Colton’s face, as well as his thankful family.

Microsurgery Expertise and Sophisticated Operating Technology Required
Facial reanimation surgery requires the kind of microsurgical expertise that can only be acquired through years of training and experience. It also demands sophisticated operating technology to ensure surgical success. This technical expertise and state-of-the-art equipment are only available at Duke and a small number of other medical centers. 

Experienced Specialists
Facial reanimation surgery is one component of a comprehensive process that involves a team of experienced specialists. They include:

• Neuro-Ophthalmologists and Skull-Base Surgeons
  When necessary, neuro-ophthalmologists or skull-base surgeons may become involved in your care. Tightening procedures and the placement of tiny upper-eyelid implants may be recommended when facial paralysis can affect your ability to close your eyes properly.
• Therapists and Specialists
  Rehabilitation therapists are integral to your recovery. A facial rehabilitation specialist will use biofeedback techniques and exercises to help you smile naturally again. If your ability to chew is affected, you may work with an occupational therapist. A speech pathologist may help you learn to speak clearly again.