Facial Reanimation Surgery

Using Microsurgery to Restore Movement Following Facial Paralysis

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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. Duke plastic surgeons and ENT surgeons are among the few in the country skilled in these highly technical and complex procedures. Microsurgical techniques have evolved considerably over the past several years to provide results previously not possible. We successfully help people young and old regain the ability to express emotion -- even when they have been told by other doctors that nothing can be done.

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About Facial Reanimation Surgery (Smile Surgery)

Facial reanimation surgery may be recommended when you experience total or near-total loss of your ability to show facial expression. Facial paralysis may result from a birth-related condition such as Moebius Syndrome, a facial injury, or tumor surgery that involves the facial nerve. Either the facial nerve does not function properly, or facial muscles don’t develop properly or become lax and unable to perform.

Nature and Timing of Lost Nerve Function Determines Type of Surgery
Facial reanimation surgery can take two forms, depending on the nature and timing of the lost nerve function:

  • Microsurgical muscle transfer can restore the ability to smile in people born without facial movement or with longstanding facial paralysis.
  • Nerve transfers or grafts can restore facial muscle function in people who previously had facial movement but lost function following tumor surgery or trauma.

One or Two Stages
Facial reanimation is performed in one or two stages. When procedures are performed in two stages, they are often separated by a period of 9–12 months. Many factors are taken into consideration when determining the best approach, including your age, the cause of your facial paralysis, and whether it affects one side of your face (unilateral) or both (bilateral).  Your surgeon will explain this when recommending the process that will achieve the best possible results for you.

If You've Lost Facial Function You Had Before, Timing Is Important
The earlier you are seen, the better your outcome will be, as the newly transferred facial nerve may be able to regain control of your existing facial muscles before they become permanently paralyzed.

Other Procedures Don't Restore Facial Movement
Less sophisticated, more readily available procedures tighten or lift a drooping face to a more attractive position but don’t restore facial movement. Facial reanimation surgery restores or replaces lost facial movement. It may not create a perfectly symmetrical smile or completely restore a natural eyelid blink, but over time it will restore your ability to express your emotions through more natural facial movement.

Our Locations

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

Am I a Candidate for Facial Reanimation Surgery?

Candidates for facial reanimation surgery have little to no smile movement, particularly smile or eye closure. A comprehensive consultation will help determine if facial reanimation is right for your condition. Before your visit, our doctors will want to know:

  • What is the cause of your facial paralysis?
  • When did your facial paralysis begin and how long have you had it?
  • Have you had any prior surgery, procedures, or nonsurgical therapy?
  • Can you provide results of past tests?

We also want to review photographs or video demonstrating your ability or inability to perform the following movements:

  • Rest
  • Eyebrow elevation
  • Eye closure and tight eye closure
  • Natural smile (with no teeth showing)
  • Big smile (with teeth showing)
  • Pucker

Maximum Facial Movement Results Take Time
It may take one year or more to see maximum facial movement following facial reanimation surgery and rehabilitation therapy.

Facial Reanimation Surgery Isn't for Everyone
For example, elderly patients or people with medical conditions that prevent them from undergoing lengthy surgeries may not be candidates for this complex process. In these cases, or when incomplete paralysis is present, we may recommend other surgical or nonsurgical methods to improve the balance of your facial appearance and help you regain some facial movement.

Born with Moebius Syndrome, Colton’s facial muscles were so weak that he was unable to show expression. Facial reanimation surgery at Duke Children’s Hospital brought a smile to Colton’s face, as well as his thankful family.

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Our Team Approach

Microsurgery Expertise and Sophisticated Operating Technology Required
Facial reanimation surgery requires the kind of microsurgical expertise that can only be acquired through years of training and experience. It also demands sophisticated operating technology to ensure surgical success. This technical expertise and state-of-the-art equipment are only available at Duke and a small number of other medical centers. 

Experienced Specialists
Facial reanimation surgery is one component of a comprehensive process that involves a team of experienced specialists. They include:

  • Neuro-Ophthalmologists and Skull-Base Surgeons
    When necessary, neuro-ophthalmologists or skull-base surgeons may become involved in your care. Tightening procedures and the placement of tiny upper-eyelid implants may be recommended when facial paralysis can affect your ability to close your eyes properly.
  • Therapists and Specialists
    Rehabilitation therapists are integral to your recovery. A facial rehabilitation specialist will use biofeedback techniques and exercises to help you smile naturally again. 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 once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 10 pediatric specialties by U.S. News & World Report for 2024–2025.

This page was medically reviewed on 05/05/2020 by