Has your facial paralysis not improved?
Request a specialised assessment and discover the different facial reanimation surgery options that may help you.
When is surgery indicated for facial paralysis?
Many people believe that, once facial paralysis stops improving during the first few months, there is no longer any rehabilitation treatment capable of restoring facial movement. This misconception leads many patients to live for years with difficulty smiling, speaking, drinking or fully closing the eye, without ever consulting a specialist. The reality is very different.
Even when spontaneous recovery of the facial nerve has stopped and rehabilitation or botulinum toxin treatment no longer provides improvement, there are facial paralysis surgery and facial reanimation surgery techniques that can restore part of the lost function, improve facial symmetry and recover essential movements such as smiling and eyelid closure.
However, not everyone with facial paralysis requires surgery. During the first few months after a facial nerve injury, the goal is usually to promote recovery through medical treatment, specialised rehabilitation and close clinical follow-up. In later stages of facial paralysis, when recovery no longer progresses or the resulting sequelae significantly affect quality of life, surgery becomes one of the available treatment options.
Facial paralysis surgery is commonly recommended for patients with:
· Permanent facial paralysis or very limited chances of spontaneous recovery.
· Sequelae following surgery for an acoustic neuroma or other skull base tumours.
· Traumatic injuries to the facial nerve.
· Congenital facial paralysis.
· Inability to fully close the eye (lagophthalmos).
· Marked facial asymmetry when smiling or complete absence of facial movement.
· Functional impairments that make speaking, eating, drinking or expressing emotions difficult.
These situations, however, are only general guidelines. The decision to perform surgery is never based on a single factor, but rather on a comprehensive assessment of the patient. The most appropriate treatment depends on factors such as the cause of the injury, the time elapsed since the onset of facial paralysis, the condition of the facial muscles, any previous procedures and each patient's functional goals.
For this reason, two patients with the same facial paralysis may require completely different treatments. While some still retain viable facial muscles and may benefit from nerve transfer or facial reinnervation techniques, others achieve better results through muscle transfers, facial suspension procedures or a personalised combination of different facial reanimation techniques.
Before recommending any surgical procedure, our team performs a comprehensive assessment that includes a clinical examination, imaging tests, neurophysiological studies and a detailed evaluation of facial function.
The sooner facial paralysis that has stopped improving is assessed, the greater the chances of restoring functions that may otherwise be permanently lost over time.
How can we help you?
Facial reanimation surgery is not a single operation. It is a set of procedures tailored to the needs of each patient with facial paralysis, aimed at restoring different facial functions.
Restoring your smile
Loss of the ability to smile is one of the most significant consequences of facial paralysis, with a major impact on quality of life. Through facial reanimation techniques, it is possible to restore movement to the corner of the mouth and achieve a more natural and balanced smile.
Restoring facial movement
When the facial muscles still retain the ability to respond, nerve transfer techniques can restore nerve impulses to the facial muscles, allowing voluntary—and in some cases even spontaneous—facial movements to return.
Improving eyelid closure
The inability to fully close the eye caused by facial paralysis not only leads to discomfort, but may also compromise the health of the ocular surface.
We offer specific procedures designed to improve eyelid closure, protect the cornea and restore eyelid function.
Correcting facial asymmetry
Loss of muscle tone causes the facial tissues to gradually sag over time.
Facial suspension and repositioning techniques help restore greater facial symmetry, both at rest and during movement.
Treating complex sequelae
Many patients come to our clinic after undergoing surgery for an acoustic neuroma, a brain tumour, traumatic injuries or complex head and neck surgery.
In these cases, the goal is to reconstruct facial function using the most advanced techniques available, while tailoring treatment to each patient's individual characteristics.
Every case of facial paralysis is different. Its treatment should be too.
Request a specialised assessment and discover which facial paralysis surgery options can help you restore facial function, your smile and your quality of life.
What surgical techniques exist for facial paralysis?
One of the most important messages we convey during the first consultation is that there is no single surgical procedure for facial paralysis. For some patients, the priority is to restore their smile. For others, it is to achieve complete eyelid closure to protect the cornea. In other cases, the main goal is to improve facial symmetry at rest or reduce the sequelae of previous surgeries. For this reason, the surgical plan usually combines different procedures to achieve the best possible outcome.
Today, we have a wide range of surgical procedures designed to address the different problems caused by facial paralysis. Rather than being independent facial paralysis surgery techniques, they should be understood as complementary tools that the surgeon combines according to each patient's specific needs.
Dynamic surgery: restoring movement
Dynamic surgery has one clear objective: to restore facial movement. To achieve this, new nerve connections are created to carry electrical impulses to muscles that are no longer receiving signals. In other words, new "pathways" are created so the brain can once again communicate with the facial muscles.
This is what we refer to as facial reanimation surgery, as its purpose is to restore active movement rather than simply improving facial position. Depending on the individual case, these movements may initially be voluntary and, over time, with rehabilitation, become increasingly natural and spontaneous.
Static surgery: improving facial symmetry
It is not always possible to restore facial movement. In some patients, the facial muscles can no longer respond, even if a new nerve supply is provided. In these situations, we use static surgical procedures, which aim to reposition tissues that have lost tone in order to improve facial symmetry.
These techniques work in a similar way to a functional facelift, elevating the corner of the mouth and other facial structures to restore facial balance, improve appearance at rest and facilitate certain everyday functions.
Static surgery is often combined with dynamic procedures to optimise the final result.
Nerve transfers: creating a new pathway to restore your smile
Nerve transfers represent one of the greatest advances in facial reanimation surgery. When the facial nerve has lost its ability to transmit signals, other healthy nerves, such as the masseteric nerve or, in selected cases, the healthy-side facial nerve (cross-face nerve graft), can be used to create new connections with the facial muscles.
Following surgery, a specialised rehabilitation programme helps the brain learn to use these new nerve pathways, allowing movements such as smiling to gradually return and facial expressions to become increasingly natural.
Muscle transfers: when the muscle can no longer recover
If many months or years have passed since the injury, the facial muscles may have permanently lost their ability to respond. In these cases, simply providing a new nerve is no longer enough.
The solution involves using functional muscles from other parts of the body or neighbouring muscles capable of generating new facial movements. One of the most widely used procedures involves repositioning the temporalis muscle tendon, a muscle involved in chewing, so that it helps elevate the corner of the mouth and restore the smile.
In other patients, free muscle transfers may be considered, particularly when more complex facial movements need to be reconstructed.
Restoring eyelid closure
The inability to fully close the eye is one of the most common and potentially serious consequences of facial paralysis.
When the eyelid remains open, the cornea loses its natural protection, increasing the risk of irritation, dry eye and injuries that may compromise vision. Protecting the eye is therefore always a priority.
Depending on the severity of the condition, treatment may include oculoplastic surgery procedures to improve the position of the lower eyelid or the placement of an eyelid weight, which helps achieve complete eye closure by using the natural weight of the upper eyelid.
Restoring your smile: much more than moving the mouth
For most patients, restoring their smile means much more than achieving a surgical goal. It means expressing joy again, communicating with confidence and recovering a fundamental part of their identity.
The smile is one of the most complex facial expressions in the human body and one of the most important in our personal relationships. That is why every surgical plan revolves around one very specific objective: achieving a balanced, functional and as natural a smile as possible.
Today we know that no single technique can achieve this on its own. The best results come from combining procedures tailored to each patient, integrating surgery, rehabilitation and long-term follow-up to help the new movement become part of the patient's everyday facial expression.
Why operate on your facial paralysis at barnaclínic+?
Choosing where to undergo facial paralysis surgery means much more than simply choosing a hospital.
Facial reanimation surgery combines expertise in microsurgery, neurosurgery, reconstructive surgery, rehabilitation and neurophysiology. The experience of the medical team and close collaboration between specialists are essential to achieving the best possible outcome.
At barnaclínic+, patients benefit from the care model and clinical excellence of the Hospital Clínic de Barcelona, with a comprehensive approach focused on restoring facial function and supporting patients throughout their recovery.
Extensive experience in facial reanimation surgery
Facial paralysis surgery is one of the most complex fields within reconstructive surgery. Our team has extensive experience in advanced facial reanimation techniques, facial nerve reconstruction, nerve transfers, muscle transfers, eyelid surgery, and procedures designed to restore smiling and facial movement.
Every procedure is individually planned to select the combination of techniques that best suits each patient's needs.
All treatment options within a single specialised unit
Not every patient requires the same type of facial paralysis surgery. Some benefit from dynamic surgery, others from static procedures, while many achieve the best results through a combination of surgery, specialised rehabilitation and long-term functional follow-up.
Having all these treatment options within the same multidisciplinary team allows us to design a personalised treatment plan based exclusively on medical criteria.
A specialised multidisciplinary team
Facial paralysis surgery requires collaboration between different specialists. At barnaclínic+, our professionals work together across Plastic, Reconstructive and Aesthetic Surgery, Neurosurgery, Physical Medicine and Rehabilitation, Neurology, Ophthalmology and Otorhinolaryngology (ENT).
This comprehensive approach enables us to treat not only the surgical condition itself, but also all the functional consequences associated with facial nerve injury.
Technology, precision and safety
Surgical planning, microsurgical techniques and intraoperative monitoring improve surgical precision and optimise the preservation of nerve structures.
Our goal is to provide the most appropriate facial paralysis treatment with the highest level of safety and the lowest possible functional impact.
The Hospital Clínic de Barcelona environment
barnaclínic+ is part of the healthcare network linked to Hospital Clínic de Barcelona, one of Spain's leading national and international referral centres.
All patient care is delivered according to up-to-date clinical protocols and an evidence-based approach.
Frequently asked questions about facial paralysis surgery
When is facial paralysis surgery recommended?
Facial paralysis surgery is usually considered when spontaneous recovery has stopped or when significant sequelae affect facial function, smiling or eyelid closure. The indication depends on the cause of the injury, the time since onset and the condition of the facial muscles.
Can facial paralysis that has been present for several years still be treated surgically?
Yes. Although some techniques achieve the best results when performed during the first few months, many people with long-standing facial paralysis can still benefit from reconstructive procedures designed to improve facial function and symmetry.
What is the difference between dynamic and static surgery?
Dynamic surgery aims to restore facial movement by creating new nerve or muscle connections. Static surgery improves facial position and symmetry when restoring facial movement is no longer possible, or as a complement to other procedures.
Is it possible to smile again after facial paralysis?
Yes. Many patients are able to smile again after facial paralysis. Modern facial reanimation surgery techniques make it possible to partially or completely restore the ability to smile, although the outcome depends on the characteristics of each individual case.
What are nerve transfers?
Nerve transfers are microsurgical procedures that use healthy nerves to redirect nerve signals to the facial muscles, helping to restore movement.
What happens if I cannot completely close my eye after facial paralysis?
If you are unable to fully close your eye, there are specific treatments designed to protect the ocular surface and improve eyelid closure, including reconstructive procedures and the placement of eyelid weights when indicated.
Does surgery completely eliminate facial asymmetry?
The goal is to achieve the greatest possible functional and aesthetic recovery. Although results vary from one patient to another, many people experience a significant improvement in facial symmetry, both at rest and during movement.
How long does recovery take after facial paralysis surgery?
Recovery after facial paralysis surgery depends on the type of procedure performed. With facial reanimation techniques, new movements usually appear gradually over the months following surgery and continue to improve thanks to specialised rehabilitation tailored to each stage of facial paralysis.
Will I need rehabilitation after surgery?
Yes. Facial paralysis rehabilitation is an essential part of treatment, helping patients learn how to use their new nerve connections, improve muscle coordination and maximise functional recovery.
Does facial paralysis surgery only improve appearance?
No. Although facial symmetry improves in many patients, the main goal is to restore essential functions such as smiling, closing the eye, speaking, eating and expressing emotions more naturally.
Restoring your smile begins with a specialist assessment
Every case of facial paralysis is different and requires a personalised treatment plan. Our team can help you understand which surgical options are available in your case and what your realistic chances of recovery are.
Request your first consultation and discover how facial reanimation surgery can help you restore function, facial expression and confidence.
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