For those who struggle with Bell’s Palsy, symptom flare-ups can leave them feeling less than their best. When those symptoms are severe, long-lasting, or unresponsive to less invasive treatment options, reconstructive surgery may be a good option. In this blog, Dr. Sam DeVictor of Plastic and Reconstructive Surgery – a Division of U.S. Dermatology Partners, discusses exactly what Bell’s Palsy is, when surgery is recommended, surgical treatment options, and even non-surgical solutions.
Understanding Bell’s Palsy
According to the American Academy of Otolaryngology–Head and Neck Surgery, Bell’s Palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell’s palsy may cause significant speech issues, feeding issues, an inability to close the eyelid, involuntary movements of the face, and asymmetrical facial appearance.
Bell’s Palsy requires diagnosis by a professional, but some of the common warning signs include:
- One-sided facial paralysis
- Smoothing out of facial creases, forehead lines, and nasolabial folds
- Drooping in the corner of the mouth
- Inability to completely close eyelids
- Lower eyelid sagging
- The eye rolls upward when attempting to close (Bell’s phenomenon)
- Eye irritation from exposure and lack of lubrication
- Decreased tear production
- Eyes may look teary due to loss of lid control, allowing eyes to water unimpeded
- Food, drinks, and saliva may pool on the side of the mouth, with paralysis
In most cases, these symptoms will increase over the first three days to a week before they plateau and begin to diminish. While some may see symptoms increase for longer, this is usually a warning sign that the individual is dealing with a condition other than Bell’s palsy. Any patient experiencing these symptoms should be evaluated carefully to ensure an accurate diagnosis and to maximize treatment planning.
Bell’s Palsy is considered an idiopathic condition because the specific underlying cause isn’t known, but there are several factors that increase the risk for this condition, including:
- Herpes simplex virus (HSV) – HSV is the virus responsible for cold sores and genital herpes outbreaks. While a causal connection between HSV and Bell’s palsy hasn’t been established, research indicates that the majority of patients with Bell’s palsy also had elevated HSV titration.
- Diabetes – In the Journal of Neurology, Neurosurgery, and Psychiatry, researchers P. Pecket and A. Schattner found that 39% of patients with Bell’s palsy also had diabetes. This isn’t a huge surprise since neuropathy (nerve damage) is a common symptom of diabetes.
- Lyme Disease – This condition can impact the peripheral or central nervous system, including causing inflammation that leads to palsy.
- Age – While anyone of any age can develop Bell’s palsy, it is more common in older adults with a peak in occurrence in the 40s.
Exploring Surgical Treatments for Bell’s Palsy
The American Academy of Otolaryngology–Head and Neck Surgery reports that Bell’s Palsy symptoms resolve on their own within three weeks for 85% of people who don’t seek treatment. For others, minimally invasive treatment options, which will be described later in this blog, offer adequate improvement. However, some patients have severe or longer-lasting symptoms that require more advanced interventions like surgical treatments for Bell’s Palsy.
Surgical treatments may include:
- Blepharoplasty – Eyelid surgery may be recommended to lift drooping eyelids, tighten skin, and restore the ability to fully close eyes.
- Brow Lift – A surgical procedure to lift drooping brows that may occur due to facial paralysis.
- Cranial Nerve Transfer – If nerves are permanently damaged due to Bell’s Palsy, a cranial nerve transfer may be recommended. This procedure involves attaching a functional nerve to a damaged nerve to restore function.
- Facelift – A surgical procedure used to lift the skin, muscles, and other facial structures.
- Platinum Eyelid Weights – Small weights inserted into eyelids to restore the ability to fully close eyes.
- Selective Myectomy – When Bell’s palsy leads to synkinesis (unwanted muscle contraction), this surgical procedure divides muscles to balance movements.
- Selective Neurolysis – For those who have involuntary facial movements related to Bell’s Palsy, this treatment prevents nerves from misfiring to stop involuntary movement.
- Static Suspension – Tissue from the thigh is used to lift drooping cheek and mouth.
- Temporalis Tendon Transfer – When the corner of the mouth droops, this procedure can be used to pull up the lip and restore natural symmetry.
What to Expect: Risks & Success Rates of Surgeries Following Bell’s Palsy
According to Dr. DeVictor, “All surgical procedures have associated risks. A skilled facial plastic surgeon can help you mitigate the potential risks of surgery related to facial paralysis recovery by providing step-by-step instructions to prepare for and recover from surgical procedures.”
Risks may include:
- Swelling
- Bruising
- Bleeding
- Pain and discomfort
- Infection
- Scarring
Beyond Surgery: Alternative Treatments for Bell’s Palsy
In addition to considering surgical options for Bell’s Palsy, non-surgical options are available. Botox is often used to improve the asymmetry that may result from facial paralysis as well as to combat unwanted muscle contractions or spasms. Most importantly, the inability to fully close the eye can lead to dry eyes, poor tear formation, and even vision loss if not cared for. Eye drops, eye ointment, and eye care are very important throughout the journey. For those who have dry eye or ocular irritation, eye drops and other treatments may be recommended.
Other non-surgical treatments that may be recommended for Bell’s Palsy include:
- Botox – Treats Bell’s Palsy-related nerve damage and synkinesis.
- Dermal Fillers – Can restore lost facial volume or reshape soft tissue that has become misshapen due to Bell’s Palsy.
- Physical Therapy – Facial paralysis can shrink or weaken facial muscles over time. With physical therapy, patients restore function and range of motion.
Wrapping Up: The Importance of Professional Medical Advice in Treating Bell’s Palsy
In conclusion, Dr. DeVictor says, “At the end of the day, the most important thing you can do to improve your Bell’s Palsy symptoms is seek out advice from a specialist. It all starts with a thorough evaluation and accurate diagnosis. After providing a complete evaluation, a physician or facial plastic surgeon can offer treatment options that help you improve symptoms and loss of function following Bell’s Palsy. While many people do see symptom resolution without treatment, there are numerous options available to mitigate the severity and longevity of these issues.”
Learn More About Bell’s Palsy
If you struggle with Bell’s Palsy, you’ve received surgical treatment for this condition, or you have questions about your treatment options, we’d love to hear from you. When you’re ready to start planning your facial plastic surgery treatment, take a few moments to complete our online request form to schedule a consultation visit to explore your options with one of our trusted professionals.
Sources
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- “Bell’s Palsy – Symptoms and Causes – Mayo Clinic.” Mayo Clinic, 4 May 2022, www.mayoclinic.org/diseases-conditions/bells-palsy/symptoms-causes/syc-20370028.
- “Neurologic Lyme Disease | CDC.” Centers for Disease Control and Prevention, 11 Aug. 2021, www.cdc.gov/lyme/treatment/NeurologicLyme.html#:~:text=Neurologic%20symptoms%20of%20Lyme%20disease,both%20sides%20of%20the%20face.
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- National Organization for Rare Disorders. “Bell’s Palsy – Symptoms, Causes, Treatment | NORD.” National Organization for Rare Disorders, 12 Jan. 2023, rarediseases.org/rare-diseases/bells-palsy/#complete-report.
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