The facial nerve is large nerve of the head that controls many important movements of your face such as smiling, frowning, chewing, furrowing your brow. This nerve may be damaged for many reasons such as trauma, surgery, stroke, brain growths, infection or a birth-related condition. This may result in permanent facial weakness (also known as facial palsy or facial paralysis), which results in noticeable drooping of the affected side of your face. You may also experience problems with speaking, blinking, swallowing saliva, eating or communicating through natural facial expressions.
Facial reanimation is a type of surgery that restores movement, function, and symmetry to your face to revitalise your ability to close your eyes, talk, chew, drink and smile.
From the time of facial nerve damage, the facial muscles will slowly lose their ability to contract over the months (atrophy). Once the muscles have completely atrophied, the options of surgical treatment to correct this problem become more limited. Thus, it is important to be reviewed by a facial reanimation specialist as early as possible to maximise your success of facial reanimation.
Depending on the severity of your facial weakness and duration since the time of nerve damage, the following procedures may be recommended:
a) Nerve proceduresFrom the time of facial nerve damage, the facial muscles remain healthy for about 18 months before they completely shrink and lose their ability to function (atrophy). Thus, if no more than a year has passed since your facial paralysis began, it may be possible to restore the nerve stimulus to the facial muscles by transferring a nerve to that area. Examples include:
Recovery of movement after any nerve procedure takes months as nerve regrowth is very slow. It can take many months for muscle control to return on the paralysed side of the face.
b) Muscle transpositionHealthy muscle on the paralysed side can be rerouted to replace a function that has been lost after facial paralysis. Most commonly, one of the chewing muscles (temporalis muscle or masseter muscle) is used to restore smiling, as these muscles are powered by a nerve different from the facial nerve. This allows the person to smile on the paralysed side by clenching the jaw.
c) Muscle transferIn this procedure, healthy muscle is taken with its nerve and blood supply from another area – commonly the thigh (gracilis muscle) or back (latissimus dorsi muscle) – and implanted into the paralysed side of the face. As nerve regrowth into the muscle is slow, it can take many months for muscle control to return on the paralysed side of the face.
d) “Static” proceduresThese simpler procedures allow quick improvement in the symmetry of the face but do not restore facial movement. Examples include:
After the Surgery
The recovery process for reanimation procedures varies depending on which procedure is performed, whether you have more than one procedure, your age and health, and how long your nerves and muscles have been paralysed. Painkillers and antibiotics will be prescribed to control the pain and minimize the risk of infection. For more complex procedures, you will stay in hospital for a few days until you have recovered sufficiently for discharge.
Your surgeon will see you regularly in clinic afterwards to monitor your wound healing and recovery of facial function. If you have had a nerve or muscle procedure, facial nerve rehabilitation therapy after surgery is key to maximising the results of your procedure. A specialised facial physical therapist will review you regularly over the months and guide you through the necessary exercises in your ensuing months of recovery.
It may take one year or more to achieve maximum facial movement following facial reanimation surgery and rehabilitation therapy.
Understanding the Risks
As with any major surgery, facial reanimation carries risks such as:
You may need to undergo revision surgery to correct these problems. The subject of risks, as well as potential complications of surgery are best discussed on a personal basis between you and your plastic surgeon.