Dynamic Facial Reanimation
Recreating a voluntary smile through nerve and muscle transfer.
Learn moreFacial Reconstruction
Facial Paralysis Reconstruction
Restoring movement and symmetry lost after damage to the facial nerve, using reconstructive surgical techniques.
At a glance
- Operating time
- 4–8 hours
- Anaesthesia
- General anaesthesia
- Hospital stay
- 3 nights
- Back to desk work
- approx. 21 days
- Social recovery
- approx. 42 days
About this procedure
Facial paralysis is the inability of the muscles on one side of the face to move because the facial nerve has been damaged; closing the eye, smiling, speaking and eating can be affected. Depending on the cause and duration of the paralysis, reconstruction aims to protect the eye, improve facial symmetry and, in suitable patients, restore movement.
Surgical approach and technique
The plan is individual and may involve one or several stages. Surgery is performed under general anaesthesia and takes 4–8 hours depending on the procedure. Methods include nerve transfers (using the chewing nerve or a nerve graft from the other side of the face), a microsurgical muscle transfer from the leg (gracilis), static sling techniques and procedures that help the eyelid close. Usually 3 nights are spent in hospital.
Who is it for?
Considered for facial paralysis that has not recovered after Bell's palsy, that follows tumour surgery or trauma, or that is congenital. Which method suits the patient is decided at examination according to how long the paralysis has lasted and the state of the muscles.
Recovery
Return to work usually takes 3 weeks and to social life about 6 weeks. After nerve and muscle transfers, movement takes months to begin; the first movements are usually seen within 3–9 months. Facial exercises and physiotherapy are an important part of the process.
Who it may not suit
- If the paralysis is still in its period of spontaneous recovery: waiting and follow-up come first
- If general health does not allow a long anaesthetic: more limited procedures are considered
Methods by how long the paralysis has lasted
| Period | State of the muscles | Usually considered |
|---|---|---|
| Early (mostly the first 1–2 years) | Facial muscles still alive | Nerve transfer |
| Late | Muscles have lost their function | Muscle transfer from the leg (gracilis) |
| At any stage | — | Eye-protecting procedures, static slings, symmetry procedures |
Preparing for surgery
- Examination with photographs and video
- Nerve and muscle function tests (EMG) if needed
- Blood tests and an anaesthetic assessment
- Stopping smoking and nicotine products
Recovery timeline
| When | What to generally expect |
|---|---|
| Days 1–3 | Monitoring in hospital |
| Weeks 1–2 | Swelling and stitches; check-up |
| About week 3 | Return to desk work |
| About week 6 | Return to social life |
| Months 3–9 | First movements through the transferred nerve or muscle; physiotherapy |
| 1–2 years | Movement and symmetry continue to improve |
For patients travelling from abroad
We usually recommend staying in Istanbul for 10–14 nights. Later follow-up and the exercise programme continue online. A second visit may be needed for plans with several stages.
Possible risks
Like any surgery, facial paralysis reconstruction carries risks, and all of them are shared with you in writing before the operation:
- Risks related to general anaesthesia
- Bleeding
- Infection
- Failure of the blood vessel connection in a muscle transfer
- Movement more limited than hoped
- Asymmetry
- A scar on the leg (with a gracilis transfer)
- Need for further refinement
Back to desk work: approx. 21 days. Social recovery: approx. 42 days. Depending on the scope of surgery you should plan for between 6 and 12 nights. The exact figure is confirmed in writing with your treatment plan.
The information on this page is general and does not replace medical advice. Timings and recovery vary between individuals; a definitive plan can only be made after examination.
Frequently asked questions
Will I be able to smile again after surgery?
In suitable patients a smile movement can be restored on the paralysed side through a nerve or muscle transfer. How much movement returns varies from person to person and is discussed at examination.
How long after facial paralysis should surgery be considered?
The timing depends on the cause of the paralysis and how long it has lasted. In conditions such as Bell's palsy, 6–12 months are usually allowed for the nerve to recover on its own. While the facial muscles are still alive, usually within the first 1–2 years, a nerve transfer can get them working again. If the paralysis has lasted longer and the muscles have lost their function, methods such as a muscle transfer from the leg (gracilis) are considered for the smile. That is why an early examination matters.
My eye does not close. What can be done?
When the eye does not close, protecting the cornea comes first. Closure can be supported with a small weight placed in the eyelid or with procedures that tighten the eyelid. These can be planned together with other treatments.
What is a gracilis muscle transfer?
A thin muscle from the inner thigh is taken with its blood vessel and nerve and transferred to the face with microsurgery. It is connected to the chewing nerve or to a nerve brought across from the other side of the face, with the aim of producing a smile.
When does the transferred muscle start to work?
Because nerves take time to heal, the first movements are usually seen within 3–9 months. The time depends on the nerve the muscle is connected to. Movement keeps improving over the following months.
Does taking a muscle from the leg affect walking?
Other muscles in the leg take over the work of the gracilis, so walking and everyday movement are generally not affected. A scar remains on the inner thigh.
Is physiotherapy needed?
Yes. Once the transferred nerve or muscle starts to work, facial exercises are important for improving control of the movement and symmetry. For patients abroad the programme is followed up online.
How much does it cost?
The fee is given according to the personal plan set after examination. The quote covers the operation, anaesthesia, hospital, medication, transfers and follow-up visits.
Related procedures
Free Gracilis Muscle Transfer
Microsurgical transfer of the gracilis muscle from the thigh to the face to restore smile movement.
Learn moreFacial Asymmetry Surgery
Rebalancing congenital or acquired facial asymmetry at the level of volume, bone and soft tissue.
Learn morePost-Traumatic Facial Reconstruction
Repairing fractures, tissue loss and scarring with equal attention to function and appearance.
Learn moreA personal assessment for this procedure
Share your photographs and let us plan the right technique and timeline together.
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