Facial Paralysis Treatment Options
The facial nerve controls the movement and expression of the facial muscles, including the smile. Facial nerve paralysis is physically, aesthetically and emotionally devastating to an individual. Facial paralysis can be brought on by genetic disorder, disease, a complication from surgery, Bell’s Palsy or even an accident, to name a few. Overcoming the effects of facial paralysis is a long and difficult process. Dr. Azizzadeh and his staff will do everything they can to facilitate you through each step of the journey to facial reanimation.
Extensive experience and training is required to treat patients with facial nerve disorders. Dr. Azizzadeh is the Director of the Facial Paralysis Institute and is one of the leading figures in the field of Facial Nerve Paralysis. Dr. Azizzadeh is trained in Facial Plastic & Reconstructive Surgery, as well as Head & Neck Surgery, giving him a distinctive insight into facial nerve function and facial aesthetics.
Furthermore, Dr. Azizzadeh trained extensively in microsurgical facial reconstruction, which is often required for the treatment of children and adults who are born with facial paralysis. When other doctors tell a patient there is nothing that can be done to cure their facial paralysis, often times Dr. Azizzadeh is able to help.
Since his training at Harvard Medical School, he has helped thousands of men, women and children afflicted with varying degrees of facial paralysis. Due to his expertise in facial paralysis, he is the author of the preeminent textbook on the subject entitled “The Facial Nerve”, has published hundreds of peer-reviewed articles on facial paralysis and Bell’s palsy, and is invited to lecture around the world on his cutting-edge surgical techniques.
His amazing transformations have appeared on The Oprah Winfrey Show (with Mary Jo Buttafuco’s amazing transformation), The Doctors with Gracie’s heart-touching story, and countless other national print and television media outlets.
Dr. Azizzadeh On The Oprah Winfrey Show with Mary Jo Buttafuoco
Dr. Azizzadeh On The Doctors Show With Patient Gracie
Dr. Azizzadeh On The Doctors Show With Patient Kalli
What is facial paralysis?
Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of their face. This is usually a result of damage to the facial nerve. Patient’s suffering from facial paralysis will have asymmetrical facial expressions and often times will suffer from functional disabilities like chewing, swallowing, breathing, and speaking.
What causes facial paralysis?
Facial paralysis presents when any structures innervated by the facial nerve becomes paralyzed. Since the pathway of the facial nerve is long and relatively convoluted, there are numerous causes of facial paralysis. It is imperative that we determine the cause of the facial paralysis in order to treat it properly. Facial paralysis causes include:
- Bell’s Palsy
- Acoustic neuroma surgery
- Parotid surgery
- Moebius Syndrome
- Ramsay Hunt Syndrome
- Stroke and other central nervous system disorder
- Herpes Zoster Oticus
- Melkersson-Rosenthal Syndrome
- Hemifacial microsomia
- Middle ear infections
- Lyme disease
Many doctors who do not have expert knowledge in facial paralysis will misdiagnose the cause of facial paralysis, which can be detrimental to a patient. If you have facial paralysis you should make sure to see a specialist to determine the true cause of your paralysis.
What are the symptoms of facial paralysis?
Patients with facial paralysis can suffer from a range of functional and aesthetic impairments. Common facial paralysis impairments can include:
- Facial asymmetry
- Depression of brows
- Inability to close the eyelids (lagophthalmos)
- Paralysis of lower eyelid (ectropion)
- Decreased tear production
- Corneal damage
- Mid-face drooping
- Effacement of the nasolabial fold (“laugh line”)
- Nasal airway obstruction, secondary external valve collapse
- Inability to smile (asymmetry)
- Oral incompetence and drooling
- Lower lip deficit
What factors are taken into consideration when planning facial paralysis treatment?
Once Dr. Azizzadeh determines the cause of the facial paralysis, he is then able to develop an appropriate treatment plan for the patient. Other factors that are very important in determining the correct medical and surgical management of patients with facial nerve paralysis include:
- Etiology of paralysis (cause of paralysis)
- Degree of paralysis
- Duration of paralysis
- Patient’s age
- Patient’s state of health
- Patient’s desires
What are the facial paralysis surgery options?
Facial paralysis surgery is very complex and must be done by an expert, like Dr. Azizzadeh, who has had extensive training in the facial nerve and performs these surgeries on a weekly basis. The most important treatment objectives for individuals with facial paralysis are the prevention of unwanted eye complications, restoration and reconstruction of facial movement, restoration of a dynamic smile, and improvement of facial aesthetics.
Dr. Azizzadeh emphasizes a team approach when performing facial paralysis surgery so that the patients receive the best care possible. His team includes otolaryngologists, head and neck surgeons, ophthalmologists and physical therapists. Three regions of the face are addressed during facial paralysis treatment and surgery:
Brow and eyelid region
- Gold weight placement to help upper eyelid closure
- Surgical tightening of the lower eyelid
- Endoscopic brow lift to improve eye brow position and symmetry
Smile and mid-face region
- Selective neurolysis decreases the activity of the nerves that counter the smile mechanism to help get an upward trajectory of the mouth and improve synkinesis
- Nerve transplant to create a dynamic smile (most important goal)
- Facelift procedure to improve symmetry and aesthetics of the face
- Subperiosteal midface lift (midface drooping)
- Creation of nasolabial fold (“laugh line”) utilizing suture techniques
- Static suspension of nasal ala to improve nasal breathing
- “Touch-up” procedures
Lower face and lips
- Lower lip wedge excision
- Asymmetric facelift
- Dynamic lip depressor rehabilitation
What happens after facial paralysis surgery?
Finally, physical therapy is an indispensable tool for getting the most out of facial paralysis reconstruction. The commitment to undergo long-term physical therapy is a pre-requisite for any patient desiring significant improvement in facial function and appearance.
Dr. Azizzadeh’s goal is to provide a physical therapy program that will facilitate facial symmetry and improve facial paralysis. With the proper exercise and physical therapy, facial paralysis patients can recover some of their lost facial movement and regain the animation in their facial expressions.
Facial paralysis and Bell’s Palsy are a challenge for the plastic surgeon because of the complex nerve and muscle work. Babak Azizzadeh, MD, an assistant clinical professor at UCLA, is one of a small number of surgeons in the US who is specialized in repairing facial paralysis. Dr. Azizzadeh is board-certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology-Head and Neck Surgery. He is founder of the Facial Paralysis and Bell’s Palsy Non-Profit Foundation.
Facial Paralysis Case Study – Gracie
Gracie, a 12-year-old girl, faced paralysis after a cavernous hemangioma (CH) in her brain began to bleed. The bleeding caused paralysis to the right side of her body, making her unable to control her face and limbs.
After the initial surgery to stabilize her condition, Gracie and her parents began their search for a facial paralysis specialist. Aside from Dr. Azizzadeh’s expertise with facial paralysis surgery, the family also found comfort in the fact that he has worked with several other children, something very few surgeons have experience with.
To date, Gracie has had several surgeries and gone through countless hours of therapy to restore movement and function to the right side of her face. She has had 3 surgeries with Dr. Azizzadeh over the past two years. The overall goal of her surgeries is to restore more normal facial movements and expressions and to create the best possible facial symmetry.
During the first surgery, Dr. Azizzadeh took a piece of nerve from her leg and attached it to her non-paralyzed facial nerve.
Several months later, Dr. Azizzadeh performed a second surgery in which he brought in a brand new muscle from her inner thigh, the gracilis muscle. The gracilis muscle and it’s artery, vein and nerve were hooked up to the nerve that was transplanted in the original surgery and to the artery and vein on the left side of her face.
In the third surgery, Dr. Azizzadeh checked on the muscle that was previously transplanted to make sure it was healthy and functioning properly. He also repositioned some of Gracie’s tissue to create more symmetry with the other side of her face and to redefine her cheeks.
Today, Gracie is able to smile and make facial expressions that are much closer to her normal facial movements prior to paralysis.
To see more pictures of patient’s before and after facial paralysis surgery with Dr. Azizzadeh visit our photo gallery.
Please contact facial paralysis surgeon Dr. Azizzadeh if you or your family have any further questions or desire to be seen in consultation. Dr. Azizzadeh is also the author of several books on the topics of facial plastic surgery and facial rejuvenation.
For more information about facial paralysis and Bell’s palsy treatment options, please visit: http://www.facialparalysisinstitute.com