Facial Palsy and Reanimation

The most common type is Bell’s palsy. It usually comes on suddenly and is believed to be linked to a viral infection. It typically resolves on its own within a few months without treatment.

Facial palsy, though, can have many causes that are more serious. It may happen after a stroke, head or face injury or following surgery (especially surgery on your inner ear). A head, neck or brain tumour or autoimmune condition — such as multiple sclerosis (MS) or Guillain-Barré syndrome — can also cause facial palsy. In rare cases, it can also be present at birth. Moebius syndrome is a congenital facial palsy that happens when certain cranial nerves don’t develop properly during pregnancy.

Getting an accurate diagnosis early is crucial. It can help prevent muscle wasting and give you the best possible outcome. If you’ve had previous treatment that hasn’t been effective, we can help guide your care in the right direction.

If your consultant feels that a serious underlying condition may be causing your facial palsy, they will promptly involve the appropriate specialists.

What to expect at your first appointment

Your consultant will begin by asking about your medical history and your symptoms. They may also ask you to try certain facial movements, such as:

• Smiling
• Raising your eyebrows
• Opening and closing your eyes
• Frowning

This helps them see which muscles are weak and whether the whole side of your face is affected or just part of it.

They will also ask how quickly your symptoms started, and if you have other symptoms, such as ear pain, changes in taste, ringing in your ears (tinnitus) or trouble hearing.

Often, your consultant will be able to diagnose the cause of your facial palsy quickly based on a physical exam and your medical history. If the cause is still unclear or your palsy is more complex, they may arrange some tests to help confirm a diagnosis. Some of these tests may be carried out during your appointment, while others may need to be scheduled for a later date.

Testing for facial palsy

These tests help us take a deeper look into your condition. You might have:

• Blood tests: Help rule out conditions like Lyme disease, diabetes or infections
• CT scan and MRI: Provide detailed images of your nerves and surrounding structures
• Electromyography (EMG): Checks the electrical activity of your facial muscles
• Nerve conduction study (NCS): Measures how well your facial nerves are working and whether there is any damage

A Team Approach to Care

From your first consultation to recovery, our team works together to create a seamless, personalised pathway of care. Depending on your individual needs at each stage, your care may involve your GP and a range of specialist consultants, including: 

• Neurologists
• Oncologists
• Ophthalmologists 
• Neurosurgeons
• Ear, nose and throat (ENT) surgeons
• Plastic and reconstructive surgeons
• Physiotherapists specialising in facial retraining
• Clinical psychologists
• Specialist nurses

Whether your facial palsy has started recently or you have been living with it for some time, we can help improve facial movement and function. Our team can help ease discomfort and address issues such as drooping, muscle weakness and unwanted facial movements (synkinesis).

The treatment we recommend will depend on the cause and severity of your facial palsy. This might involve a single therapy or a combination of approaches tailored to your needs. Using photographs, videos and specialised software, we can track your progress and help you see the improvements over time.

Medications

There are several medications we may use to treat your facial palsy. They include:

• Antivirals: Treat viral infections that may cause facial palsy
• Botulinum toxin injections (Botox^®): Relax facial muscles and decrease synkinesis
• Corticosteroids: Reduce swelling of your facial nerve

Facial retraining

Facial retraining therapy is a specialised form of physiotherapy for your face. These exercises can help strengthen your facial muscles and train them to move correctly. They can also support your recovery after facial surgery.

At Cleveland Clinic London, our facial retraining therapists have a thorough understanding of the face’s complex anatomy and extensive experience caring for people with facial palsy. They work closely with our surgeons, contributing their detailed knowledge to the planning and delivery of each operation.

Facial reanimation surgery

If surgery is recommended, you can be confident that your care is in expert hands. Facial reanimation surgery includes a range of procedures designed to help restore facial movement, improve symmetry and protect eye and facial function.

Depending on your needs, you may have:

• Facial nerve repair: Reconnects damaged nerve ends
• Nerve transfers: Reroutes or transplants part of a healthy nerve
• Functional muscle transfer: Moves a small thigh muscle to your face
• Oculoplastic surgery: Corrects drooping eyelids or eyebrows
• Selective neurectomy/neurolysis: Removes certain nerve branches to reduce synkinesis
• Static facial suspension: Uses tissues to lift the corner of your mouth
• Temporalis tendon transfer: Moves a chewing muscle to the corner of your mouth
• Facial cosmetic procedures: Includes face and neck lifts, eyelid surgery, brow lifts, dermal fillers and laser skin resurfacing to improve symmetry and appearance

Paying for Facial Palsy Care at Cleveland Clinic London

We offer a convenient self-pay option and accept most private health insurance policies. Please reach out if you have questions or would like support with the financial aspects of your care.

What’s Next?

Facial palsy can have a significant impact on both facial movement and confidence. At Cleveland Clinic London, we put you at the centre of your care, taking the time to understand your specific challenges, priorities and goals. Our team works with you to develop a personalised treatment plan designed to improve facial function, restore symmetry and support a steady, positive recovery.