October 1, 2026 Author : Luis Vieira (Reconstructive and Aesthetic Plastic Surgery) Peripheral facial paralysis is a condition resulting from dysfunction or injury of the facial nerve . This nerve is responsible for facial movement and expression. There are several known causes of peripheral facial paralysis: Idiopathic, meaning there is no identifiable specific cause, commonly referred to as Bell's palsy; Traumatic injuries to the facial nerve; Secondary to oncological resections, most commonly parotid gland surgery and acoustic neuroma surgery; Congenital causes. Some of these conditions do not require surgical treatment, as patients may recover spontaneously or with medical treatment and rehabilitation. For patients with permanent deficits , surgical treatment can correct a significant proportion of the resulting impairments and substantially improve quality of life. Purpose and main indications The goal of facial paralysis surgery is to restore the affected facial expressions and reduce the asymmetries that occur in these patients. The main indications for surgical intervention are: Facial paralysis with no expectation of recovery, generally due to structural damage to the facial nerve. Cases in which nerve recovery cannot be reliably predicted. In these situations, early (or prophylactic) surgical procedures may be performed to preserve muscle function or improve future reconstructive options. In addition to aesthetic improvement, facial paralysis surgery can enhance essential everyday functions , including speaking, smiling, chewing, drinking without leakage, adequately closing the eyes, and expressing emotions through facial movements. Types of facial paralysis surgery The type of surgery depends primarily on the length of time since the onset of paralysis. After several months without nerve stimulation, facial muscles begin to atrophy, making nerve reconstruction techniques less effective. In general, nerve reconstruction procedures achieve the best results when performed within the first 12 to 18 months after the onset of paralysis. However, treatment decisions depend on multiple factors, including individual patient characteristics and nature of the underlying condition. Therefore: If paralysis has been present for less than 12 to 18 months, preference is generally given to nerve surgery , involving facial nerve reconstruction or transfer of function from other nerves, such as the masseteric, hypoglossal, or accessory nerves. If paralysis is considered chronic , meaning it has lasted for more than 18 months, nerve surgery is usually no longer viable. In such cases, replacement of the affected muscles becomes necessary . This may involve using other face muscles and supplied by other nerves, or transferring muscles from other parts of the body using microsurgical techniques and connecting them to nerves other than the facial nerve. For example, when facial paralysis affects the muscles responsible for smiling: If paralysis has been present for less than 18 months, the preferred procedure is often a nerve transfer, such as transferring the masseteric nerve to the buccal branches of the facial nerve. If paralysis has persisted for more than 18 months, surgical treatment may involve transferring a muscle from another part of the body to the face. This muscle is then reinnervated either by the facial nerve on the opposite side or by another nerve within the same side of the face. There is also a group of surgical techniques aimed at improving functional outcomes, particularly around the eyes. Patients with facial paralysis affecting the zygomatic and frontal branches of the facial nerve may benefit from procedures such as: Brow lift surgery; Placement of a gold weight in the upper eyelid; Lower eyelid canthopexy. These procedures are designed to improve eyebrow position, protect the ocular surface, and facilitate eyelid closure, thereby reducing the risk of dry eye, keratitis, and other eye-related complications. Postoperative rehabilitation Rehabilitation following surgery is a fundamental part of treatment . Depending on the procedure performed, several months may be required to achieve the desired outcomes. During this period, Physical Medicine and Rehabilitation therapies help patients relearn lost movements and optimize the results of surgery. Meet the reconstructive and aesthetic plastic surgery clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item. English translation generated with AI and reviewed by the editorial team.
