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Treatments and Procedures: Facial Paralysis Surgery

Nerve damage due to trauma or other conditions, such as Bell’s palsy, can lead to an inability to move the muscles of the face, on one side or both. Facial paralysis can make it difficult to speak, blink, swallow or smile. When facial paralysis does not resolve on its own, surgery can address the problem.

Facial Paralysis Treatment: Before and After Pictures

Treatment for Facial Paralysis
Facial Reanimation

Result after two stage cross facial nerve graft and Gracilis flap for smile restoration to correct right sided facial paralysis resulting from resection of acoustic neuroma. To produce an engaging smile the procedure is tailored to lift the upper lip to show teeth, define the smile lines to match the unaffected side, raise the Malay fat pads to reflect light and raise the corners of the mouth evenly. Right eyelid procedures were also performed to match the size of the unaffected side. The first and second procedures were performed 6 months apart.


Treatment for Facial Paralysis
Facial Reanimation

​Result of smile restoring surgery for complete left sided facial paralysis.

Treatment : Dual innervation with a combination of cross facial nerve graft and hypoglossal nerve transfer. The cross facial nerve graft recruits facial nerve function from the normal right face to allow a spontaneous smile and movement on the left side. The hypoglossal nerve restores tone to the left face and keep the lips symmetric when she talks.

Treatment for Facial Paralysis
Facial Reanimation

​Diagnosis: Right facial paralysis.

Treatment: Temporal Tendon Transfer (T3); browlift; lower eye lid surgery; reconstruction of right lower lid with a medical and lateral eyelid lift surgery.

Treatment for Facial Paralysis
Facial Reanimation

Diagnosis: left facial paralysis.

Treatment: Temporal Tendon Transfer (T3) surgery, left brow lift, left face lift and placement of gold weight implant.

Treatment for Facial Paralysis
Facial Reanimation

Diagnosis: facial paralysis after a parotidectomy

Treatment: Temporal Tendon Transfer (T3) surgery, which doesn't cause any noticeable swelling or deformity of the face.

Treatment for Facial Paralysis
Facial Reanimation

Result after two stage cross facial nerve graft and Gracilis flap for smile restoration to correct right sided facial paralysis resulting from resection of acoustic neuroma. To produce an engaging smile the procedure is tailored to lift the upper lip to show teeth, define the smile lines to match the unaffected side, raise the Malay fat pads to reflect light and raise the corners of the mouth evenly. Right eyelid procedures were also performed to match the size of the unaffected side. The first and second procedures were performed 6 months apart.


Treatment for Facial Paralysis
Facial Reanimation

​Result of smile restoring surgery for complete left sided facial paralysis.

Treatment : Dual innervation with a combination of cross facial nerve graft and hypoglossal nerve transfer. The cross facial nerve graft recruits facial nerve function from the normal right face to allow a spontaneous smile and movement on the left side. The hypoglossal nerve restores tone to the left face and keep the lips symmetric when she talks.

Treatment for Facial Paralysis
Facial Reanimation

​Diagnosis: Right facial paralysis.

Treatment: Temporal Tendon Transfer (T3); browlift; lower eye lid surgery; reconstruction of right lower lid with a medical and lateral eyelid lift surgery.

Treatment for Facial Paralysis
Facial Reanimation

Diagnosis: left facial paralysis.

Treatment: Temporal Tendon Transfer (T3) surgery, left brow lift, left face lift and placement of gold weight implant.

Treatment for Facial Paralysis
Facial Reanimation

Diagnosis: facial paralysis after a parotidectomy

Treatment: Temporal Tendon Transfer (T3) surgery, which doesn't cause any noticeable swelling or deformity of the face.

Facial Paralysis: Why Choose Johns Hopkins Facial Plastic Surgery?

  • Our surgeons are internationally renowned, including two of the most highly regarded in the world for the treatment of facial paralysis.
  • With the large number of patients we see and our faculty’s experience, which includes specific training in the structure of the head and neck region, we offer a rare degree of skill and expertise even in the most complex procedures.
  • The team’s unique skills in surgical reanimation techniques can address paralysis of the face, including nerve and tendon transfers, microvascular surgery and oculoplastics.
  • Our experts at Johns Hopkins have contributed many innovations to the field of facial reanimation, including the recent advancement of powering the gracilis muscle with multiple nerve sources including the cross face nerve and the masseteric nerve. This facilitates the spontaneous smile of the cross facial nerve graft with added power from the masseteric nerve. 

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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.

Facial Paralysis Surgery: What to Expect

A number of surgical procedures can restore movement to the lower part of the face. Some of these procedures involve moving facial nerves, tendons and muscles (or parts of them) from other areas of the body to the face.

Surgery to transplant muscle tissue may involve more than one procedure and hospital stays of several days for each stage.

Your individualized treatment plan may involve one or more of these procedures:

Temporalis Tendon Transfer (T3): This is a relatively simple procedure that moves the temporalis muscle and tendon from one location in the face to another.

Gracilis Muscle Transplant (Gracilis Free Flap): The surgeon transfers a small portion of a thin muscle of the inner thigh to replace facial muscles.

Cross-Facial Nerve Graft: The surgeon moves a nerve from one side of the face to the other to supply a transplanted muscle with the ability to contract.

Masseteric Muscle Transfer: One branch of the muscle that helps people chew is re-routed to a new area in the face.

Hypoglossal Nerve Transfer: The surgeon can relocate a portion of the facial nerve that moves the tongue to a position that enables a transplanted muscle to function.

Facial Paralysis Patient Smiles Again

 

Follow Anthony’s journey as he has a masseter nerve transfer and eyelid surgery and experiences an improved quality of life.

Patrick Byrne and Kofi Boahene

Our Physicians

Meet Drs. Kofi Boahene and Patrick Byrne

Our doctors are board certified in both otolaryngology—head and neck surgery and facial plastic and reconstructive surgery, which gives our team a unique and comprehensive level of expertise.

Meet Dr. Byrne Meet Dr. Boahene
 

Different Surgeries, Same Result

 

Hear from patients who have had temporalis tendon transfer (T3) and gracilis free flap, two surgical techniques used for long-standing facial paralysis. 

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