Facial Paralysis Surgery

Dr. Brownlee is one of Oklahoma’s only surgeons specially trained in the management of facial paralysis. Facial paralysis, which means the muscles of one or both sides of the face stop working properly, can happen for several reasons, including trauma, tumors, infection or Bell’s palsy. This can make it hard to smile, blink or show emotion normally. Some types of paralysis get better on their own within a year, but sometimes recovery of movement is incomplete. In other cases, surgery or other treatments may be needed. Each person’s condition is different, so the treatment plan is always personalized.

There are both non-surgical and surgical management options. For people with synkinesis, a chronic condition where facial muscles misfire and create disfiguring facial expressions, Botox can be used to relax facial muscles and improve symmetry. However, Botox is temporary, and treatment needs to be continued every three months. In some cases, a surgery called a selective neurectomy can help provide long-term relief by dividing the nerves that are causing unwanted movements.

For other types of facial paralysis, there are different surgical options to restore movement or improve appearance. A gracilis free muscle transfer uses a small muscle from the thigh to create a new smile. A temporalis tendon transfer or masseter nerve transfer uses nearby muscles or nerves to help restore motion to the face. For patients who aren’t candidates for movement-restoring procedures, a static sling can gently lift the face and improve symmetry at rest. These surgeries seek to match your natural look and give you back the ability to express yourself.

Services Offered

Botox for Synkinesis

Botox is a safe, non-surgical treatment used to relax overactive facial muscles in patients with synkinesis. Oftentimes after patients heal from facial paralysis, their facial muscle can begin to contract in unwanted ways—like the eye closing when trying to smile. Botox works by weakening specific muscles that are moving in unwanted ways, helping restore facial balance and improve both function and appearance. Treatments are done in the office, take just a few minutes, and typically last about 3–4 months.

Selective Neurectomy/Selective Myectomy For Synkinesis

Selective neurectomy is a surgical option for patients with synkinesis and have trialed Botox but would like more long-term management. In this procedure, a facelift incision approaches small branches of the facial nerve that are causing unwanted movements, which are then carefully divided. The goal is to reduce abnormal pulling while preserving or improving smile symmetry.

A selective myectomy weakens specific muscles, such as the frown, eye and neck muscles. Nearly all patients who undergo selective neurectomy and/or myectomy continue to need Botox after surgery, but the frequency and amount of Botox needed are dramatically decreased.

Eyelid Weight Placement And Eyelid Tightening

When the facial nerve is weak or paralyzed, the upper eyelid may not close fully, leaving the eye exposed and dry. To help protect the eye, a small platinum eyelid weight, custom-fit to the patient in the clinic, is surgically placed inside the upper eyelid. The weight helps the eyelid close naturally using gravity. This procedure can be performed in the clinic or in the operating room, and the weight is hidden under the skin so it’s not visible to others.

Facial paralysis can also cause the lower eyelid to droop, contributing to incomplete eye closure. Eyelid tightening, also known as lateral canthoplasty or canthopexy, is a surgical procedure that lifts and supports the lower eyelid. It is often combined with an eyelid weight and is typically performed in the operating room.

Temporalis Tendon Transfer

Temporalis tendon transfer is a surgery used to help people with long-term facial paralysis (greater than two years) regain the ability to smile. The temporalis muscle, which is used for chewing, is reoriented and connected to the corner of the mouth. When the patient activates the muscle by biting down it pulls the mouth upward into a smile. Over time, patients can learn to smile more naturally without needing to bite. It is a reliable option for improving facial movement in patients who are not candidates for nerve-based procedures.

Static Sling

A static sling is a surgical option used to improve facial symmetry in patients with facial paralysis, especially when restoring movement isn’t possible. In this procedure, a strip of tough tissue from the thigh called fascia lata is used to lift the corner of the mouth and support the cheek in a more natural, balanced position. Unlike procedures that restore muscle movement, a static sling doesn’t create an active smile, but it provides important support at rest and is often used in combination with other procedures.

Nerve Transfers

The masseteric nerve is a branch of the nerve that helps control chewing. In facial paralysis surgery, this nerve can be connected to other nerves in the face or as part of a gracilis free flap to help restore the ability to smile. The masseter nerve transfer technique can often be done in a single stage, and smile movement may reliably begin to return in as little as four months. Over time, many patients learn to smile without needing to bite down.

A cross-facial nerve graft is typically used in a two-stage procedure, especially in children or younger patients with long-term paralysis. In the first stage, a sensory nerve from the leg, called the sural nerve, is removed and tunneled from the healthy side of the face across to the paralyzed side. This new nerve pathway serves as a conduit for the healthy nerve to grow across the face to the paralyzed side. Nine months later, a muscle like the gracilis is connected to the graft in a second surgery. This technique allows the patient to regain a spontaneous, emotional smile.

Free Muscle Transfer (Gracilis)

The gracilis free flap is a surgery that helps restore the ability to smile in people with facial paralysis that has been present for more than two years. In this procedure, a small muscle called the gracilis, taken from the inner thigh, is transferred to the face. This muscle is connected to nerves and blood vessels in the face so that, over time, it can move and create a natural-looking smile. After this surgery, most patients stay in the hospital for about three days.

There are two main ways to power the muscle. In a two-stage procedure, which is more common in children, a nerve graft is attached to the facial nerve on the healthy side and tunneled to the paralyzed side (called a cross-facial nerve graft). Around nine months later, a second surgery is performed to connect the gracilis muscle to this nerve. In a single-stage procedure, the gracilis muscle is connected directly to the nerve used for chewing (the masseter nerve), allowing for quicker recovery and movement.

Most patients begin to see their new smile develop within four to six months following the surgery.