Eyelid Surgery In Facial Paralysis (Bell's Palsy)

Neigel Center for Cosmetic and Laser Surgery

Please go to our redesigned web site by clicking here.

Eyelid Surgery in Facial Paralysis (Bell's Palsy)

Patients with facial paralysis either from Bell's Palsy or neurosurgery such as for acoustic neuroma can certainly benefit from eyelid surgery.

The facial paralysis, usually on just one side of the face, can cause many different problems of the eyelid and facial skin and muscles. Because the forehead on the paralyzed side of the face has no wrinkles and is unable to raise that eyebrow, the eyebrow droops, which tends to push the eyelid tissues down either over the eyelashes or over the eye. Although the eyelid itself can open, it has difficulty closing, leading to exposure of the eye, decreased blink, dry eye and in severe cases, corneal ulcers and loss of the eye with perforation from infection.

The lower eyelid, because it lacks muscle tone from the loss of nerve stimulus, droops and may even start to turn out (ectropion). The cheek and mouth muscles also droop, which can lead to drooling and trouble with eating and drinking, not to mention loss of the smile on the affected side.

Some of these conditions can be corrected with eyelid surgery.

First, the eyebrow may need to be elevated with a brow lift either directly through a forehead incision or endoscopically (through a tiny light pipe) in the scalp. The best result is usually obtained with a direct incision placed where a normal wrinkle line should exist on the forehead.

Once the eyebrow is elevated, a conservative blepharoplasty can be performed to remove any excess skin and muscle from the upper lid, so it does not block the peripheral vision. If the eye does not close, a gold weight can be implanted into the eyelid to close the lid whenever the muscle relaxes. With the weight the eye can still open normally. Springs can also be placed around the eyelids but these may cause problems such as extrusion.

As a temporary measure, part of the eyelids may need to be sewn shut to protect the eye. This procedure, called a tarsorrhaphy, will block the peripheral vision. In most patients this does not need to be a long-term solution. The lids can be opened and a gold weight inserted. The reversal of a tarsorrhaphy would result in a more normal appearance and better peripheral vision.

The lower lid often needs to be tightened up, for appearance as well as function, to protect the eye and help eyelid closure. At the same time, a lower lid blepharoplasty can be performed if needed. Any droopiness of the lower lid would be corrected at this time.

In order to reanimate the cheek muscles and the mouth and bring back a smile, sometimes a temporalis muscle transfer can be done to give some nerve stimulus to the mouth muscles. But despite repositioning the eyelids and reanimation procedures, most patients require the use of artificial tears, lubricating ointments and sometimes punctal plugs (tear duct plugs that block drainage of tears and keep the natural tears lubricating the eyes).

Facial exercises may also improve muscle tone and help the facial nerve to reinnervate, but the jury is still out on whether these exercises really do work. There is certainly no harm in trying them.