Facial Paralysis

facialparalysislosangeles-Facial paralysis affects thousands of people around the world. At La Peer Health Systems, the director of our facial nerve team is facial plastic and reconstructive surgeon Dr. Babak Azizzadeh. As a Harvard-trained, board-certified facial plastic and reconstructive surgeon, Dr. Azizzadeh strives to always help those experiencing facial paralysis with a variety of surgeries and treatments.



A person experiences facial paralysis when they no longer have the ability to move one or several facial or eye muscles. Facial paralysis can be both permanent and temporary, depending on the cause as well as the length of time that passed before it was brought to the attention of a medical professional.


There are many reasons why facial paralysis may occur, and these include:

  • Acoustic neuroma
  • Facial trauma
  • Parotid tumors
  • Stroke
  • Intracranial vascular malformation
  • Intracranial tumors
  • Cosmetic surgery
  • Lyme Disease
  • Congenital
  • Mobius Syndrome


The herpes simplex virus often is considered the leading cause of Bell’s palsy. Other viruses that may Bell’s palsy include:

  • Chickenpox
  • Shingles
  • Genital herpes
  • Epstein-Barr virus (EBV)
  • Mumps
  • Influenza B
  • Hand-foot-and-mouth disease (coxsackievirus)


Common Bell’s palsy symptoms include:

  • Paralysis on one side of the face
  • Difficulty closing the eyelids
  • Eye irritation
  • Reduction in tear production
  • Drooping near one side of the mouth
  • Drooling from one side of the mouth
  • Inability to smile, frown or make other facial expressions
  • Altered sense of taste
  • Sensitivity to sound
  • Headache
  • Pain in front of or behind the ear

If an individual experiences one or more of the following Bell’s palsy symptoms, he or she should seek immediate treatment. By doing so, this individual can receive a Bell’s palsy diagnosis and determine the best way to treat this condition.


Several Bell’s palsy treatments are available, and these include:

  • Botox
  • Prednisolone
  • Eye lubrication
  • Antivirals

In most instances, the aforementioned treatments enable an individual to alleviate Bell’s palsy symptoms. If these treatments fail to deliver the desired results, however, surgery may be required.


Selective neurolysis is a cutting-edge Bell’s palsy surgery pioneered by Dr. Azizzadeh. It is intended for Bell’s palsy patients who struggle to generate a smile and addresses abnormal regeneration of the facial nerve.

Prior to administering selective neurolysis, Dr. Azizzadeh will conduct an in-depth patient evaluation. Then, if a patient is a viable candidate for Bell’s palsy surgery, Dr. Azizzadeh crafts a custom treatment plan to alleviate this individual’s Bell’s palsy symptoms.


Many surgical treatments are available to help patients address facial paralysis symptoms. Dr. Azizzadeh, a globally recognized facial plastic and reconstructive surgeon, is happy to teach patients about all aspects of facial paralysis surgery. He also provides personalized facial paralysis surgery recommendations to ensure each patient can achieve the best-possible treatment results.


During a selective neurolysis procedure, Dr. Azizzadeh uses an intraoperative electromyography (EMG) to map out the facial nerves. Next, he explores ways to reduce the activity of facial nerves that hinder the smile mechanism. Dr. Azizzadeh then releases the platysma muscles that pulls the corner of the mouth down.

Selective neurolysis is an intricate operation. It has been shown to help Bell’s palsy patients regain a natural-looking smile. The surgery also is performed at an outpatient center and requires minimal downtime and risks in comparison to other facial nerve procedures. Best of all, patients typically start to see the results of selective neurolysis one day after treatment.


An emotional spontaneous smile is the ultimate goal of any patient suffering from facial paralysis. There are only a few operations that can truly achieve this outcome. The cross facial nerve graft, when combined with gracilis muscle flap, is the gold standard for patient with long-standing facial paralysis.

In short, a cross facial nerve graft aims to allow a patient to regain facial movement on the paralyzed side of their face by manipulating the facial nerve of the working side of the face through a surgical nerve transplant. Undergoing a facial nerve graft requires a great deal of time and patience from anyone suffering from facial paralysis, as it can take up to and exceeding a year to complete.

During this type of procedure, a facial paralysis surgeon harvests a nerve (the sural nerve) from the patient, usually from the lower leg. This nerve is then attached to the patient’s normal facial nerve on the opposite side of the paralysis, which still has movement. In the next part of the procedure, the gracilis muscle is harvested from the inner thigh and attached to the nerve graft as well as an artery and vein in the neck. This allows the paralyzed side of the face to spontaneously and emotionally move when the patient smiles or speaks.

When a patient chooses to undergo this type of surgery, physical therapy is generally needed for up to 18 months. Throughout the first several months after the second stage of the surgery, patients will gradually begin to see an increase in facial movement on the paralyzed side of the face. This will continue to improve for the next couple of years. Dr. Azizzadeh has written several textbooks on facial plastic and reconstructive surgery, including one dedicated entirely to facial paralysis procedures.


During a static sling procedure, a structure similar to that of a tendon is taken from the thighs to aid in the creation of a laugh line. Then, a surgeon will make an incision in front of the ear that heals extremely well.

A static sling can help treat a variety of ailments that accompany facial paralysis. These include the following:

  • Re-position drooping mouth and face
  • Fix facial symmetry
  • Regaining control over inner gum biting and drooling
  • Re-create a laugh line

During this procedure, a structure similar to that of a tendon is taken from the thighs to aid in the creation of a laugh line. To perform the procedure, an experienced facial paralysis surgeon will make an incision in front of the ear that heals extremely well. Then, the tendon is properly placed underneath the skin and will not be visible at all. Some patients may elect to undergo facelift procedure to further create symmetry and improve differential aging process.

Following this type of procedure, the patient usually sees a significant improvement in facial symmetry, as well as symmetry of the lips and mouth.


When the facial nerve cannot be reattached, a facial plastic and reconstructive surgeon may perform a nerve graft in which a nerve is harvested from a different area of the patient’s body and reconnected to the severed facial nerve.

Following nerve repair, the recovery process can be slow and requires patience, though it can be different for every patient.


The temporalis tendon transfer is one of the most common ways to improve facial symmetry and allow dynamic restoration of the smile. This procedure is an excellent one-stage option that can improve symmetry, reduce functional deficits associated with facial paralysis, and provide dynamic smile mechanism. The procedure is typically performed as an outpatient same day surgery and patients with complete facial paralysis are candidates.

The procedure is performed by taking advantage of the muscles that allow us to chew. The temporalis muscle’s tendon is attached to the corner of the mouth through limited incisions restoring symmetry and function.

Physical therapy is required to help patients learn to smile in a new way.


The trigeminal-facial nerve transfer, popularized by Dr. Babak Azizzadeh, is one of the most effective ways of restoring a natural smile in patients who have had facial paralysis of less than three-year duration as a result of trauma, tumor, vascular malformation, and acoustic neuromas. The masseteric nerve (branch of the trigeminal nerve) is attached to the patient’s facial nerve, allowing the patient to smile in the most natural way available. The smiles from this operation far surpass any other facial reanimation technique and often times can be combined with cross facial nerve grafts to even get better outcomes.


In certain cases of facial paralysis and Bell’s palsy, the use of Botox has become extremely prevalent and useful in the condition’s treatment. Botox can also be very helpful in treating synkinesis, or the involuntary movement of facial muscles, much like a twitch or contraction that can last for quite some time.

Botox works to relax muscles experiencing synkinesis in the face, which improves facial symmetry. Because Botox works to paralyze muscles, injecting the substance into a person experiencing facial paralysis actually helps bring balance to the facial features by lessening the drooping downward pull. To find out if you might be a good candidate to undergo Botox treatments to help overcome your facial paralysis or Bell’s palsy, please contact La Peer Health Systems today.


Sometimes, facial paralysis can result in a lowered appearance of the eyebrows. This is caused by a weakness in the muscle that holds the brow in place. A relatively easy and simple treatment option to assist a patient in the recovery process is to undergo a brow lift.

Most commonly, a mid-forehead brow lift is performed. Depending on the circumstances surrounding certain cases, a less invasive endoscopic brow lift might also be performed.


An effective procedure, known as the upper eyelid gold weight, is performed to treat cases of eyelid paralysis. Normally this procedure is done by an oculoplastic surgery team at Lapeer Health Systems made up of some of the top experts in the field of eyelid reanimation. During surgery, your surgeon will place a small gold plate in the upper eyelid to increase its weight. This weight allows the patient the ability to close their eyes and blink much easier than before.

Hyaluronic gel injections, including Juvederm and Restylane, can also be used to treat eyelid paralysis. During this procedure, your surgeon will inject the gel into the upper eyelid to increase its weight. This also assists the patient when closing the eyes and blinking.

After visiting with one of La Peer’s facial nerve experts, you’ll have a much better idea of what is necessary to treat your unique facial paralysis or eyelid paralysis case. To determine if you’re a good candidate for upper eyelid gold weight surgery or hyaluronic acid treatment, contact our staff of board-certified surgeons. Our doctors use the best and most effective techniques for the treatment of facial paralysis.


Is Bell’s palsy common?

The National Institute of Neurological Disorders and Stroke indicates Bell’s palsy affects approximately 40,000 Americans annually. Research also shows Bell’s palsy impacts men and women of all ages, but it is less common in individuals before the age of 15 or after the age of 60.

How are facial paralysis and Bell’s palsy diagnosed?

There is no surefire lab test that can be used to diagnose facial paralysis and Bell’s palsy. Conversely, Dr. Azizzadeh uses a series of tests to provide an accurate diagnosis.

Dr. Azizzadeh tests a patient for Lyme disease and hepatitis and evaluates his or her thyroid function. He also performs an in-depth neurologic and ear, nose and throat (ENT) assessment. Dr. Azizzadeh may request an ENT specialist or a facial nerve specialist consultation as well.

Additionally, Dr. Azizzadeh sometimes requests a tearing test, computed tomography (CT) scan and magnetic resonance imaging (MRI) exam to identify the root cause of a patient’s facial paralysis or Bell’s palsy symptoms. He devotes the necessary time and resources to conduct a full patient evaluation. That way, Dr. Azizzadeh helps a patient determine the best course of action to alleviate his or her facial paralysis or Bell’s palsy symptoms.

What should I expect during the recovery period following a facial paralysis surgery?

Patient downtime varies depending on the surgical procedure, but it generally ranges from a few hours to a few days. Facial paralysis surgery may be performed under anesthesia. In this instance, a patient should expect the anesthesia’s effects to subside within about 24 hours of treatment.

Will I need to take time off from work due to a facial paralysis surgery?

Most patients need to take at least one week off from work after facial paralysis surgery. This varies, however, based on the surgery. If a patient receives several surgeries in combination with one another, he or she may need additional time for recovery, too.

Are there any activity restrictions after a facial paralysis surgery?

Strenuous activities and exercise should be avoided for at least two weeks after facial paralysis surgery. Also, a patient should avoid contact sports for at least six weeks following treatment.

Dr. Azizzadeh offers comprehensive details about what a patient should expect following treatment. He provides post-recovery instructions prior to performing a facial paralysis surgery and is ready to respond to a patient’s concerns or questions at any time during the recovery cycle. By doing so, Dr. Azizzadeh helps a patient keep his or her recovery on track and reap the full benefits of a facial paralysis surgery.


La Peer Health Systems is home to world-renowned facial paralysis surgeons. Our doctors have helped hundreds of patients overcome their facial paralysis. Dr. Babak Azizzadeh is a renowned authority in the medical field, and he’s even written a textbook on the facial nerve. To find out more, please visit our contact page or call (855) 360-9119 to schedule your initial consultation in Beverly Hills.

Other Articles about Facial Paralysis

Early Use of Steroids Improves Recovery from Facial Paralysis Caused by Bell’s Palsy

Bell’s palsy, the most common cause of facial paralysis, is most likely related to nerve inflammation caused by a viral agent such as the herpes simplex virus. Facial paralysis refers to loss of facial movement due to nerve impairment and affects thousands of people around the world. It can affect one (unilateral) or both (bilateral) sides of the face and causes facial drooping. A Scandinavian study found facial paralysis treatment with steroids (prednisolone) within 72 hours of the onset of symptoms significantly reduced the number of patients with mild to moderate facial paralysis severity at 1 year regardless of whether antiviral treatment with valacyclovir was also administered.

Predict Your Facial Paralysis Surgery Results with 3D Imaging

Are you contemplating facial paralysis surgery with techniques such as the cross facial nerve graft or gracilis free flap? Advanced software technology utilizing three dimensional (3D) imaging can reveal the outcome of your facial paralysis surgery while in the initial consultation with your plastic reconstructive surgeon. A variety of 3D models can be generated and viewed from angles to specify the results of your facial paralysis treatment. The 3D technology can also be utilized for cosmetic surgery objectives, including rhinoplasty (nose job) and mentoplasty (chin augmentation). Imagine the feeling (less stress) of going into your facial paralysis surgery knowing your expected results even before the first incision and the time it takes to heal.

Botox Injections as Facial Paralysis Treatment

Botulinum toxin, better known as Botox®, injections can be utilized for facial paralysis treatment. This nerve toxin can be used to treat Bell’s palsy, the most common cause of facial paralysis, by improving facial muscle movement. Most individuals with facial paralysis secondary to Bell’s palsy recover completely in about 6 months, and Botox for facial paralysis is typically injected every 3 to 6 months. Most of us are familiar with Botox’s cosmetic application to smooth fine lines and wrinkles, giving patients a more youthful appearance, but it does have other medical uses that are becoming more commonplace such as the treatment of migraine headaches, muscle spasms, excessive sweating, and lazy eye (amblyopia).

Deviated Septum, Nasal Obstruction, and Facial Paralysis

A deviated septum represents misalignment of the bone and cartilage that divide the nose in half, and almost 80% of the population has some degree of nasal septal deviation (mostly mild). Nasal obstruction, the sensation of reduced air flow either through one nostril (unilateral) or both nostrils (bilateral), is the most common symptom of a deviated septum. A branch of the facial nerve courses very near the nostrils of the nose, and an untreated deviated septum can compress this nerve causing facial paralysis. Yes, facial paralysis, although uncommon, can be associated with a deviated septum and nasal obstruction. Other more common conditions associated with a deviated septum include sinus infections, obstructive sleep apnea, headaches, and nosebleeds.

Brow Lift: Facial Paralysis Surgery

Facial paralysis represents a loss of movement in the muscles of the face caused by damage or inflammation of the facial nerve, also known as cranial nerve (CN) VII. Facial paralysis typically manifests as drooping on one side (unilateral) of the face. Although most cases of facial paralysis are acute and resolve within 6 months with or without facial paralysis treatment, there are cases that can become chronic and may benefit from facial paralysis surgery. Common surgical techniques for facial paralysis treatment include the cross facial nerve graft and gracilis free flap. As of late, the minimally invasive brow lifting technique has emerged as a new and innovative facial paralysis surgery technique to restore the drooping brow to a more natural position and clear the patient’s visual field.

Next, read about Grave’s Disease.