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A young woman holds the side of her face in pain.
A young woman holds the side of her face in pain.
A young woman holds the side of her face in pain.

Bell's Palsy: When Facial Paralysis Doesn't Get Better

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Bell’s palsy is a rare condition that affects the facial nerve and muscles. It may appear after a cold sore or other viral illness like the flu or a cold. You might notice a headache and pain, or twitching or weakness in one side of your face.

Over the next 48 hours or so, one half of your face can start to droop. Your smile may look lopsided. One of your eyelids may sag or you may have trouble closing that eye. You may also notice a loss of the sense of taste, dizziness, ringing in your ear (tinnitus) or other symptoms that point to a problem with the facial nerve.

How long does Bell’s palsy last?

In the majority of cases, facial paralysis from Bell’s palsy is temporary. You’re likely to notice gradual improvement after about two weeks. Within six months, most people have recovered full motion and function of their face.

But if facial paralysis from Bell’s palsy doesn’t get better, surgery can help.

When should I see a doctor for Bell’s palsy?

Patrick Byrne, M.D., M.B.A. , is a professor of otolaryngology – head and neck surgery at Johns Hopkins, and heads the Facial Plastic and Reconstructive Surgery Center . He’s an expert in facial reanimation – surgery to help restore motion and expression to the face after Bell’s palsy, stroke, or other conditions.

He notes that for persistent facial paralysis, it’s best not to wait too long before consulting an expert.

“There's a window period after an initial injury when the muscles of facial expression are still salvageable,” Byrne says. “If we can intervene early and time it well, we can save the natural muscles of expression and regenerate that ability to smile and blink.”

He says he and his team of surgeons use a number of different approaches to reanimate the face after Bell’s palsy. Doctors can move a branch of nerve from elsewhere in the face and use it to replace the damaged one. If the muscles in the face no longer function, the surgeon can harvest tissue from a muscle in the inner leg called the gracilis to restore movement.

Facial Paralysis Surgical Options: What You Need to Know from a Johns Hopkins Expert

What you need to know about three options for facial reanimation surgery: masseteric nerve transfer, temporalis tendon transfer and gracilis free tissue flap from Johns Hopkins facial plastic and reconstructive surgeon Patrick Byrne.

Restoring Facial Function and More

“Johns Hopkins is a terrific place for patients with facial paralysis,” Byrne says, “because we have so much experience and expertise. We’re one of the busiest centers in the world.”

Byrne adds that his patients get a lot more than highly skilled facial plastic surgery. “We have a true team approach. In addition to surgeons, we also have a comprehensive research program that studies outcomes in facial paralysis. We are unique in that regard.”

The group also supports recovering patients with speech therapists, neurologists for facial motor testing and a facial retraining expert: a dedicated physical therapist who works with people affected by facial paralysis.

He says that the team excels in both microsurgery (the knitting together of delicate blood vessels, using a microscope) and facial aesthetic surgery (surgery to restore beauty and balance to the facial features).

“We can choose from a range of techniques we have available to restore a more beautiful, normal appearing face.”

Johns Hopkins Green Spring Station Lutherville Pavilion III

Facial Plastic and Reconstructive Care – Convenient Location

The world-renowned facial plastic and reconstructive surgeons of Johns Hopkins are now offering cosmetic and reconstructive services at Green Spring Station – Lutherville, Pavilion III, with free parking and easy access to I-695 and I-83.

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