Facial Paralysis Treatment

Facial paralysis is the loss of movement on one or both sides of your face because of a damaged facial nerve and/or facial muscles that don’t work properly. Facial paralysis can cause one side of your face to sag or spasm, or it can affect your ability to smile and show expression. It may result in drooling or difficulty closing your eyes, eating, and speaking.

Facial paralysis can occur at any time, both in childhood and adulthood. It can happen suddenly or gradually depending on the underlying cause. Some people regain movement with no treatment; however, the recovery may not be complete. Duke’s team of facial paralysis specialists evaluate your condition to determine the type and severity and recommend a personalized treatment plan. Our goals are to restore symmetry and movement to your face and to improve your quality of life.

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The Causes of Facial Paralysis

A wide range of conditions can lead to facial paralysis, and the degree to which it occurs can vary greatly in children and adults.

Congenital Facial Paralysis
May result from positioning or trauma during pregnancy or be present at birth. For example, Moebius syndrome is a congenital condition in which children are born with undeveloped facial nerves.

Bell's Palsy
Inflammation is responsible for Bell’s palsy, the most common type of facial paralysis. It can appear suddenly when a facial nerve becomes inflamed.

Trauma
A facial fracture or a deep cut on the face can damage facial nerves and muscles.

Head or Neck Tumor or Growth
A tumor or growth in the head or neck can damage facial nerves. Surgery to remove the tumor may also impact the nerves and result in facial paralysis.

Viral Infections
Viruses like HIV, Lyme disease, or Ramsay Hunt syndrome – a shingles-related infection --- can damage facial nerves.

Autoimmune Diseases
Autoimmune diseases that affect the nervous system, such as Guillain-Barré, or the brain or spinal cord, such as multiple sclerosis, can cause facial paralysis.

Synkinesis
This rewiring of the facial nerves can occur after Bell’s palsy or another facial nerve injury. Muscle spasms or the wrong facial movement (for example, your neck muscles tighten when your eye closes) can result.

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Duke Health offers locations throughout the Triangle. Find one near you.

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What to Expect at Your First Appointment

Because facial paralysis can be caused by a wide range of conditions, the first step is diagnosing the type and severity.

Comprehensive Evaluation

You will undergo an extensive evaluation that includes a physical exam, a review of your medical history, and imaging. Your doctor will check the status of your facial nerves and muscles. Pictures and videos may be taken as part of your consultation.

You Benefit from Our Team Approach

The facial paralysis team will review your records and work together to determine the best approach for your treatment. This team approach allows us to provide you with comprehensive care and takes advantage of the skills and resources of multiple specialists working together on your behalf.

Creating Your Treatment Plan

You and your doctor will discuss the team’s recommendations for your personalized treatment plan. It may include a combination of nonsurgical and surgical approaches designed to return symmetry, balance, and function to your face. Your doctor will also provide a suggested timeline for when these procedures should be performed so that you have time to heal, regenerate facial nerves, and strengthen your facial muscles.

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855-855-6484

Nonsurgical Facial Paralysis Treatments

Chemodenervation

Chemodenervation is the injection of botulism toxin into the facial nerves that control the facial muscle. It is sometimes referred to as Botox chemodenervation, but other brands of botulism toxin can be used. Periodic injections may be prescribed for synkinesis to relax the facial muscle and reduce involuntary movement.

Dermatologic Fillers

Injections of volumizing fillers may be recommended to restore reduced volume caused by muscle loss, create balance, and fix disfigurement that results from facial paralysis such as Bell’s palsy.

Facial Physical and Occupational Therapy

You may be referred to a facial rehabilitation specialist who may use biofeedback techniques and exercises to help you retrain the facial nerves and muscles. If your ability to chew is affected, you may work with an occupational therapist. A speech pathologist may help you learn to speak clearly again.

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2025–2026.

Surgery to Correct Facial Paralysis

Facial Reanimation Surgery

Facial reanimation microsurgery -- sometimes referred to as "smile surgery" -- can restore your ability to smile spontaneously after a damaged facial nerve has caused facial paralysis. It can take two forms: muscle transfer or nerve transfer.

Selective Neurolysis

This procedure may be recommended when synkinesis is present and chemodenervation and physical therapy are not effective. Selective neurolysis involves selecting and cutting the nerves that are “misfiring” so that they no longer cause abnormal facial movements.

Facial Surgeries

A variety of procedures may be performed to restore balance and create symmetry in the face when at rest. They include:

Brow lifts
Eyelid surgery
Face lifts
Facial slings

This page was medically reviewed on 09/14/2021 by

Dane M. Barrett, MD | Facial Plastic Surgeon