Overview
Facial paralysis can affect eye closing, mouth closing, speech and facial expressions. New onset facial weakness should first be evaluated medically; If it is accompanied by speech impairment or arm weakness, urgent help is required. For persistent problems, flaccid paralysis is distinguished from cases involving involuntary movements. The same surgery is not suitable for every person. Referral to a team that includes ophthalmology, neurology or ear, nose and throat specialists, reconstructive surgery, facial therapy and psychological support when necessary may be required. Goals are determined based on the individual's eye comfort, oral function, and expression needs; exact symmetry cannot be guaranteed.
What is evaluated?
- Time of onset, cause, and response to previous treatments are investigated.
- Assessment of eye closure, mouth control and involuntary linked facial movements (synkinesis).
- The usability of the muscles and possible nerve transfer options are examined by the expert team.
Approach and options
- Eye protection and expert facial therapy are planned individually.
- In selected cases of involuntary contraction, supports such as botulinum toxin may be considered.
- Nerve graft, nerve transfer, muscle transfer or static support procedures can be discussed at the relevant center.
Recovery and follow-up
Movement takes time to develop after nerve or muscle transfer and special facial therapy may be required. Eye and mouth functions are monitored separately. Initial wound healing does not indicate final movement outcome. During check-ups, symmetry, involuntary movements and the person's daily life goals are re-evaluated and the need for additional treatment is determined.
Risks and limits
- Inadequate or asymmetrical movement gain
- Involuntary movements and contractions
- Sensory or functional effects in the donor area
- Infection, scarring or need for additional treatment
The headings here do not cover all risks. Possible benefits, alternatives and personal risks should be discussed in detail during the examination.
You can ask in the consultation
- What repair options does the duration of the paralysis affect?
- What is the priority for eye safety and oral function?
- When and with whom will facial therapy be started after surgery?
Resources
- Queen Victoria Hospital — Facial palsy service ↗
- NHS — Bell's palsy ↗
- Mersey and West Lancashire NHS — Cross facial nerve graft ↗
Access to sources: September 2026. The content has been prepared for general information purposes.