Facial Reanimation Surgery

What to Expect with Facial Reanimation Surgery

Facial reanimation surgery can treat paralysis on one side of the face (unilateral) or both sides (bilateral). This type of treatment can involve smaller procedures to help eyelids close or to address a drooping lower lip. It can also include more complex treatments like nerve repair and muscle transfers.

Cross-facial nerve graft, or CFNG, is a type of facial reanimation surgery commonly used to treat one-sided (unilateral) facial paralysis. This treatment involves two surgeries spaced nine to 12 months apart:

1. First, the plastic surgeon removes a nerve from your child’s leg through a few small incisions. This will not affect your child’s ability to walk or run. Next, the surgeon makes a small incision on the strong side of your child’s face, where the ear meets the cheek. Here, the surgeon will connect the nerve from the leg to the working nerves in the strong side of the face. Next, they will tunnel the new nerve across to the weaker side of the face and place it where it can support smiling or other facial movements.
2. Nine to 12 months after the first surgery, your child will have another procedure. This time, the plastic surgeon will make an incision near the ear again and create a pocket under the cheek for new muscle. They’ll take a small muscle from your child’s leg and place it in the face, connecting it to the nerve that was grafted here in the first surgery. Removing this small muscle will not affect your child’s ability to walk or run.

If your child also has eye numbness or corneal anesthesia, also known as neurotrophic keratopathy, the surgeon may also perform corneal neurotization surgery at the same time.

After Facial Reanimation Surgery

Your child will stay in the hospital overnight after their first CFNG surgery. After the second surgery, they’ll likely be in the hospital two to four nights. At Riley Children’s Health, your care team will work with you to make sure you have a place to stay if you are travelling from out of town.

Typically, pain is easily managed for children having this surgery. Pain is treated using over-the-counter pain medications like ibuprofen and acetaminophen. After surgery, your child will:

• Eat soft foods for the first couple weeks
• Rest as much as possible and limit vigorous physical activity for about six weeks

After both procedures, it takes about four to six months for the muscle to fully function. During recovery, your child will work with a facial therapist to gain strength, control and better symmetry (evenness) in their facial movements. As your child grows older, the results should continue to improve as your child gains more control over their movements and more interest in facial symmetry.

Connect With Other Families

It can be helpful to speak with another family with a child who’s had facial reanimation surgery. The plastic surgery team at Riley Children’s Health can connect you to patients and families who have been through this kind of surgery so you can ask them questions and hear their perspectives.

Key Points to Remember

• Facial reanimation surgery typically includes cross-facial nerve graft, or CFNG. This describes two surgeries spaced several months apart. Outcomes of CNFG are better when your care team waits nine to 12 months in between the two surgeries.
• It can take four to six months for your child’s facial movements to start after the second surgery. These nerves and muscles will continue to improve over time.
• While facial reanimation surgery is available to patients of all ages, it can be most effective to have this surgery early as a child. This allows your child to develop with new facial muscles.
• Facial reanimation surgery is tailored to the specific needs of the individual.