Do you have facial paralysis that has not improved?
A specialist assessment can determine the condition of the facial nerve and muscles and identify which facial reanimation surgery options may be suitable for you.
When is surgery indicated for facial paralysis?
Many people believe that when facial paralysis stops improving during the first few months, there are no longer any rehabilitation treatments capable of restoring facial movement. This belief may lead some patients to live for years with difficulties smiling, speaking, drinking or fully closing their eye without seeking assessment from a specialist team.
The reality is different. When spontaneous recovery of the facial nerve does not occur or when persistent problems affect facial function and quality of life, different facial paralysis surgery techniques can be used to restore movement, improve facial symmetry and recover functions such as smiling or eyelid closure.
However, not everyone with facial paralysis requires surgery. During the initial stages, treatment may include medical treatment, eye protection, follow-up and specialist facial paralysis rehabilitation. When recovery is not progressing favourably or significant functional problems persist, surgery may become part of the available treatment options.
Facial paralysis surgery is usually indicated for patients with:
· Permanent facial paralysis or little likelihood of spontaneous recovery.
· Persistent problems following surgery for an acoustic neuroma or other skull base tumours.
· Traumatic facial nerve injuries.
· Congenital facial paralysis.
· Inability to fully close the eye (lagophthalmos).
· Significant smile asymmetry or absence of facial movement.
· Functional problems that make it difficult to speak, eat, drink or express emotions naturally.
These situations are only a general guide. The indication for surgery never depends on a single criterion, but rather on a comprehensive assessment. The most appropriate treatment will be determined by factors such as the cause of the injury, the time elapsed since the onset of facial paralysis, the condition and viability of the facial muscles, previous treatments or procedures, and each patient’s functional goals.
For this reason, two patients with apparently similar facial paralysis may require completely different treatments. While some patients still have viable facial muscles and may benefit from nerve transfer or facial reinnervation techniques, others may achieve better results with muscle transfers, facial suspension procedures or a personalised combination of different techniques.
Before recommending any procedure, our team carries out a comprehensive assessment to determine the cause of the paralysis, evaluate the condition of the facial nerve and muscles, and assess the potential for recovery.
The duration of facial paralysis is important
The time elapsed since the onset of facial paralysis can influence the available treatment options. During the first few months, the facial muscles may remain viable and capable of responding to a new nerve stimulus. As time passes, these muscles may progressively atrophy, reducing the possibility of using certain reinnervation techniques.
For this reason, there is no need to wait until facial paralysis is considered definitively permanent before seeking a specialist assessment. Evaluating its progression makes it possible to determine the potential for recovery and identify the best time to consider each treatment.
«The duration of the paralysis is crucial. The more time that has passed, the more likely the muscle tissue is to have atrophied and, even if we restore nerve input, it may be very difficult to make it move again».
Dr Francisco J. Cuesta González
Specialist in Oral and Maxillofacial Surgery at barnaclínic+
How can we help you?
Facial reanimation surgery does not involve a single surgical procedure. It encompasses a range of procedures tailored to the needs of each patient with facial paralysis to restore different facial functions.
Restoring the smile
Loss of the ability to smile is one of the consequences of facial paralysis that can have the greatest impact on quality of life. Different facial reanimation techniques can help restore movement of the corner of the mouth and achieve a more balanced and natural smile.
Restoring facial movement
When the facial muscles are still capable of responding, nerve transfer techniques can restore nerve stimulation to the facial muscles to recover certain voluntary movements and, in some cases, more spontaneous facial movement.
Improving eye closure
The inability to fully close the eye caused by facial paralysis not only causes discomfort but can 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 can cause facial tissues to droop and alter the position of the corner of the mouth and other facial structures.
Facial suspension and repositioning techniques can improve symmetry and may be combined with procedures designed to restore facial movement.
Treating complex facial paralysis
Some patients develop facial paralysis following surgery for an acoustic neuroma, other skull base tumours, trauma or complex head and neck procedures.
In these cases, the treatment strategy must take into account both the facial nerve injury and previous procedures and the current condition of the tissues in order to select the most appropriate reconstructive techniques.
Every case of facial paralysis is different. Treatment should be too.
Request a specialist assessment to find out which facial paralysis surgery options may help you restore facial function, your smile and your quality of life.
What surgical techniques exist for facial paralysis?
One of the most important points we explain during the first consultation is that there is no single surgical procedure for facial paralysis. For some patients, the priority will be to restore their smile. For others, it will be to achieve complete eye closure to protect the cornea. In other cases, the main goal may be to improve facial symmetry at rest or reduce the effects of previous surgery. For this reason, the surgical plan often combines different procedures to achieve the best possible outcome.
Today, we have a range of surgical procedures that can address the different problems caused by facial paralysis. Rather than considering them as separate facial paralysis surgery techniques, they should be understood as tools that the surgeon combines according to each patient’s individual needs.
Dynamic surgery: restoring facial movement
Dynamic surgery has a very clear objective: to restore movement to the face. This is achieved by creating new nerve connections capable of carrying electrical impulses to muscles that no longer receive them. In other words, new "pathways" are created so that the brain can communicate with the facial muscles again.
This type of surgery is known as facial reanimation surgery because its aim is to restore active movement rather than simply improve the position of the face. Depending on the individual case and the nerve sources used, these movements may be voluntary or may become spontaneous when the nerve input comes from the facial nerve on the unaffected side of the face.
«Facial reanimation surgery is what we call dynamic surgery».
Dr Francisco J. Cuesta González
Specialist in Oral and Maxillofacial Surgery at barnaclínic+
Static surgery: improving facial symmetry
It is not always possible to restore facial movement. In some patients, the muscles can no longer respond even if a new nerve supply is provided. In these situations, we use static surgery 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, lifting the corner of the mouth and other facial structures to restore balance to the face, improve appearance at rest and facilitate certain everyday functions.
Static surgery is often combined with dynamic procedures to optimise the final outcome.
Nerve transfers: creating a new pathway for the smile
Nerve transfers are dynamic surgical techniques that provide nerve stimulation from other functioning nerves to facial muscles that no longer receive it.
Depending on each patient’s characteristics, different nerve sources can be used, including the masseteric nerve, the hypoglossal nerve or the facial nerve on the unaffected side using cross-face nerve graft techniques.
In certain cases, different sources of nerve input can be combined with the aim of achieving the most physiological result possible and facilitating different types of facial movement.
After surgery, a specific rehabilitation programme helps the brain learn to use these new nerve pathways, allowing movements such as smiling to be gradually restored and helping the patient use the new nerve source to achieve the desired movement.
Muscle transfers: when the facial muscles can no longer recover
If a long time has passed since the injury, the facial muscles may have atrophied and lost the ability to respond adequately to new nerve stimulation. In these cases, providing a new nerve supply is no longer sufficient.
The solution involves using functioning muscles from other areas or taking advantage of nearby muscles capable of generating new facial movements. One of the most commonly used procedures involves repositioning the temporalis tendon, which is connected to a muscle involved in chewing, so that it can help lift the corner of the mouth and restore the smile.
In other patients, free muscle transfers may be considered, particularly when the aim is to reconstruct more complex facial movements.
Restoring eye closure
The inability to fully close the eye is one of the most common and potentially most serious consequences of facial paralysis.
When the eyelid remains open, the cornea loses its natural protection, increasing the risk of irritation, dry eye or injuries that may compromise vision. For this reason, protecting the eye is always a priority.
Depending on the severity of the condition, treatment may include procedures designed to reduce laxity and improve the position of the lower eyelid, as well as the placement of an upper eyelid weight, which provides the additional weight needed to facilitate more complete eye closure.
Restoring the smile: much more than moving the mouth
For most patients, restoring their smile represents much more than a surgical goal. It means being able to express joy again, communicate with greater confidence and regain a fundamental part of their identity.
Smiling is one of the most complex facial expressions and one of the gestures that has the greatest influence on our personal relationships. For this reason, restoring smile movement requires selecting the most appropriate technique according to the condition of the facial muscles and how long the paralysis has been present.
To restore movement to the corner of the mouth, facial reanimation techniques that provide nerve input from other nerves or procedures that use other muscles, such as the temporalis muscle, may be used depending on each patient’s individual characteristics.
We now know that there is no single technique capable of achieving this goal in every patient. In certain patients, combining different nerve sources can help achieve more physiological movement, while in other cases muscle techniques or a combination of dynamic and static procedures may be required.
In all these cases, surgery and rehabilitation are part of the same process, because after creating a new nerve or muscle pathway, the patient must learn how to use it and progressively integrate it into their facial expressions.
Why operate on your facial paralysis at barnaclínic+?
Choosing where to undergo facial paralysis surgery involves much more than choosing a hospital.
Facial reanimation surgery requires a highly specialised approach and may combine expertise in reconstructive surgery, maxillofacial surgery, neurosurgery, rehabilitation, neurophysiology and ophthalmology. The experience of the team and coordination between specialists are essential to select the most appropriate techniques for each case and support the patient throughout the recovery process.
At barnaclínic+, patients have access to a multidisciplinary team of professionals linked to Hospital Clínic Barcelona, with experience in treating facial paralysis and its consequences, from the initial assessment and surgical planning through to rehabilitation and subsequent follow-up.
Experience in facial reanimation surgery
Facial paralysis surgery is one of the most complex areas of reconstructive surgery. Our team has experience in advanced facial reanimation techniques, facial nerve reconstruction, nerve transfers, muscle transfers, eyelid surgery and procedures designed to restore the smile and facial movement.
Dr Francisco J. Cuesta González, a specialist in Oral and Maxillofacial Surgery at Hospital Clínic Barcelona and barnaclínic+, specialises in facial paralysis surgery and facial reanimation techniques.
Each procedure is planned individually to select the combination of techniques best suited to each patient’s characteristics.
All treatment options within the same unit
Not all patients require the same type of facial paralysis surgery. Some will benefit from dynamic surgery, others from static procedures, while many will achieve better results by combining surgery, specialist rehabilitation and functional follow-up.
Assessing these different alternatives in a coordinated way makes it possible to design a personalised treatment according to the cause of the facial paralysis, how long it has been present, the condition of the facial muscles and the functions that need to be restored.
A specialised multidisciplinary team
Facial paralysis surgery requires collaboration between different specialists. At barnaclínic+, professionals from Plastic and Reconstructive Surgery, Oral and Maxillofacial Surgery, Neurosurgery, Physical Medicine and Rehabilitation, Neurology, Ophthalmology and Otorhinolaryngology work together in a coordinated manner.
This comprehensive approach allows us to address not only the surgery itself, but also all the functional consequences associated with facial nerve injury.
Planning, precision and safety
Individualised planning for each procedure and microsurgical techniques, when indicated, make it possible to perform different facial reconstruction and reanimation procedures tailored to each patient’s characteristics.
The aim is to select the most appropriate option for each case, seeking the best possible balance between functional recovery, safety and a natural-looking result
Hospital Clínic Barcelona environment
barnaclínic+ is part of the healthcare environment linked to Hospital Clínic Barcelona, one of Spain’s leading hospitals with international recognition.
This environment facilitates a multidisciplinary approach to patients with facial paralysis, particularly in complex cases or when facial paralysis occurs as a consequence of an acoustic neuroma, other skull base tumours, trauma or previous surgical procedures.
Frequently asked questions about facial paralysis surgery
When is facial paralysis surgery indicated?
Facial paralysis surgery is usually considered when spontaneous recovery does not occur or when significant problems persist that affect facial function, smiling or eye closure. Whether surgery is indicated depends on the cause of the injury, how long the paralysis has been present and the condition of the facial nerve and muscles.
How long can I wait before considering facial paralysis surgery?
There is no single timeframe that applies to every patient. However, the duration of facial paralysis is an important factor because if the facial muscles stop receiving nerve stimulation, they may progressively atrophy, which can affect which facial reanimation techniques can be used.
For this reason, if facial paralysis is not progressing favourably, it is advisable to seek a specialist assessment without necessarily waiting until the paralysis is considered permanent.
Can facial paralysis that has been present for several years still be treated surgically?
Yes. Long-standing facial paralysis may still have treatment options, although some reinnervation techniques depend on the condition and viability of the facial muscles. When the muscles can no longer respond adequately to new nerve stimulation, other alternatives may be considered, such as muscle transfers or static procedures designed to improve specific functions and facial symmetry.
What is the difference between dynamic and static facial paralysis 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.
Can I smile again after facial paralysis?
Different facial reanimation surgery techniques can be used to restore movement to the corner of the mouth and reconstruct the smile. Depending on how long the paralysis has been present and the condition of the facial muscles, treatment may involve nerve transfers, muscle transfers or procedures such as a temporalis muscle transfer.
The extent and type of recovery will depend on each patient’s individual characteristics and the technique used.
What are nerve transfers?
Nerve transfers are facial reanimation procedures that use nerve signals from other functioning nerves to restore nerve input to specific facial muscles and recover movement.
After surgery, specialist rehabilitation helps patients learn to use these new nerve pathways to achieve the desired movement.
What happens if I cannot fully close my eye after facial paralysis?
If you cannot fully close your eye, the ocular surface may remain exposed, increasing the risk of dryness, irritation or corneal damage. Specific treatments are available to protect the eye and improve eyelid closure, including procedures to correct lower eyelid laxity and, when indicated, placement of an upper eyelid weight.
Does surgery completely correct facial asymmetry?
The aim is to achieve the greatest possible functional recovery and improvement in facial symmetry, but results vary depending on the cause of the paralysis, how long it has been present, the condition of the facial muscles and the techniques used.
Before recommending surgery, it is essential to establish with each patient what improvements can realistically be expected in their individual case.
How long does recovery from facial paralysis surgery take?
Recovery from facial paralysis surgery depends on the type of procedure performed. With facial reanimation techniques, new movements usually begin to appear gradually during the months following surgery and continue to improve with specialist rehabilitation and as the patient learns to use the new nerve or muscle pathways.
Will I need rehabilitation after surgery?
With facial reanimation techniques, rehabilitation is an integral part of treatment and plays a fundamental role in recovery. It helps patients learn to use the new nerve connections, improve muscle coordination and optimise functional outcomes.
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.
Facial paralysis can also make it difficult to control saliva and perform other everyday functions, as well as affecting the way a person communicates and interacts with others.
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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