Facial Paralysis

Midwest Facial Plastic Surgery is dedicated to providing excellence in patient care, providing comprehensive and individualized treatment plans.

Our team of Facial Plastic Surgeons, clinic experts and licensed estheticians has more than 50 years of combined experience in helping you achieve your desired results. We provide you with the most innovative and technologically advanced surgical and non­surgical procedures and treatments to help you rediscover your natural beauty so you can look and feel your best.

Facial Movement

The ability to move the face depends on 3 things:

  1. The portion of the brain that controls facial movement must be intact. For example, a stroke damages the brain and can result in full or partial facial paralysis.
  2. The facial nerve must be intact. The facial nerve is the nerve that carries impulses from the brain to the muscles of facial expression. If the nerve is damaged, the muscles cannot receive the brain’s message.
  3. The facial muscle(s) must be intact. Even if the brain and facial nerve are working perfectly, if the muscle at the end of the connection is damaged, no movement will be possible. For example, a car accident or removal of large facial cancers can damage muscles and lead to full or partial facial paralysis.

Facial paralysis can come on suddenly (in the case of Bell’s palsy, for example) or happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last for a short or extended period of time. We offer several treatments, including what are commonly called the gracilis flap and temporalis tendon transfer procedures. Both Drs. Garrett Griffin and Christopher Tolan are area experts in both the diagnosis of and treatment of facial paralysis.

Bell’s palsy is the most common cause of facial weakness or paralysis. However, it is important for physicians and patients to realize that not all cases of facial weakness or paralysis are caused by Bell’s palsy. Very serious and treatable conditions like cancer and stroke can cause facial weakness and should be ruled out before giving a diagnosis of Bell’s palsy.

Common Causes of Facial Paralysis

Common causes of facial paralysis include:

  • infection or inflammation of the facial nerve
  • head trauma
  • head or neck tumor
  • stroke


    • Weakened facial muscles or paralysis


    • Improvements in facial feature balance and self-esteem
    • Possible restoration of varying degrees of movement and function

    Other Potential Causes

    • An error in fetal development or trauma during birth
    • Accidental trauma to the nerve during a car accident or fall. Sometimes this is because there is a fracture of the bone at the skull base where the nerve enters the face
    • Autoimmune diseases including Wegener’s disease
    • Neurologic diseases including multiple sclerosis
    • Other infections including Lyme disease or shingles of the face
    • Chronic ear problems like cholesteatoma

    Are There Treatments For Complete Facial Paralysis?

    Unlike Bell’s palsy, some injuries to the facial nerve cannot recover. For example, if the nerve needs to be cut out for cancer, the nerve cannot spontaneously recover. In other instances, the nerve may be stretched and it can take up to 12 months to know if the nerve will be able to recover on its own or not. Fortunately, there are many reliable surgical treatments for chronic facial paralysis. The choice of treatment depends on how much time has passed since the injury and whether or not there is still a chance for spontaneous recovery.

    Surgical Treatments

    The surgical treatments for facial paralysis can be broken down into 5 categories:

    Static Procedures: Static procedures mean that they do not create facial movement. Likely the most common procedure performed for chronic facial paralysis is an upper lid gold or platinum weight. This is a static procedure where a small, sterile piece of gold or platinum is placed in the upper eyelid to help gravity close the eye during a blink. Another common static procedure is aptly named a “static sling.” In this surgery, the paralyzed cheek is suspended in a more symmetric, elevated position.

    Nerve Grafts: When a portion of the nerve is removed by trauma or surgery, it can be replaced with a piece from a different nerve if both cut ends of the nerve can be identified. Over time, the facial nerve fibers will grow through the nerve graft, using it like a “highway” to find the other side. Eventually, the nerve fibers will grow to the muscles allowing the return of movement. The nerve fibers (axons) grow very slowly and this process usually takes several months.

    Nerve Substitutions (hypoglossal-facial nerve transfer or masseteric-facial nerve transfer): If the facial nerve is damaged or removed very close to the brain, a nerve graft is often not possible. For example, a benign tumor of the balance nerve (vestibular schwannoma) is a common cause of facial paralysis because the balance nerve is right next to the facial nerve. This tumor usually forms just as the nerves emerge from the brain, and so it is not possible to sew a nerve graft in that location. However, it is possible to sew the nerve to the tongue (hypoglossal nerve) or a chewing nerve (masseteric nerve) to the stump of the facial nerve. Then, one can move the tongue or bite down to move the face. Often, this becomes unconscious for the patient over time as the brain relearns how to move the face. However, this technique rarely produces the ability to smile or laugh in an emotional sense. The person can smile on both sides when they want to, but not when they hear a joke or are tickled.

    Muscle Substitutions (temporalis tendon transfer): When the muscles that move the face are paralyzed for 2 years or longer, they tend to shrink or atrophy and no longer function, even if you give them back nerve input. In these instances, you have to bring a new muscle into the face instead of a nerve. The most common and modern example of this technique is called a temporalis tendon transfer. In this surgery, one of the chewing muscles (the temporalis muscle) is detached from the lower jaw and sewn to the corner of the mouth. Then, when the person bites down, it will create a smile on the paralyzed side of the face. A similar technique can also be performed where a muscle from the leg (gracilis) is moved with its blood vessels to the face and connected to one of the chewing nerves (masseteric nerve). Similarly, when the person bites down, it will create a smile on the affected side of the face.

    Cross-Facial Nerve Graft and Free Muscle Transfer: The only way to restore a completely emotional and spontaneous smile is to perform a 2-stage surgery called cross-facial nerve grafting with free muscle transfer. In the first stage, a nerve graft from the leg (sural nerve) is harvested and attached to a nerve branch that creates a smile on the normal side of the face. The nerve graft is tunneled across the upper lip and left near the corner of the mouth on the paralyzed side. After about 6 months, nerve fibers (axons) will grow across the nerve graft. At that point, the second stage is performed. A muscle from the leg (the gracilis muscle) is moved with its nerve and blood vessels to the paralyzed side of the face, and attached to blood vessels there so that the muscle will live. The nerve to the muscle is attached to the nerve graft from the first stage. Now, the brain can tell the good facial nerve, can tell the nerve graft, can tell the muscle graft, to move when laughing or smiling. The entire gracilis flap process takes about 2-3 years and has a 20% failure rate in most large studies.

    If you or a loved one is experiencing facial paralysis, call one of our two Twin Cities clinics to learn more about these treatment options.

    How Much Does Facial Plastic Surgery Cost?

    The overall cost of an Facial Plastic Surgery is affected by anesthesia fees, hospital fees, post-surgery garments, and medications. Price is also impacted by medical tests, surgeon’s fees, and the exact techniques employed.

    Schedule a Consultation

    Contact Midwest Facial Plastic Surgery today to schedule a consultation for your Facial Paralysis in Minneapolis-st. Paul And Washington County. We will take the time to guide you through the entire process, ensuring results that fully satisfy your aesthetic needs. Contact us today!


    Before + After Results

    View before and after photos of surgeries performed by facial plastic surgeons Dr. Christopher Tolan, Dr. Garrett Griffin, Dr. Zachary Farhood and Dr. Anna Bakeman in Minneapolis, MN.