Facial Nerve Paralysis Treatment

Facial nerve reconstruction is a surgical procedure aimed at treating facial nerve paralysis. The surgery consists of two main stages: the first involves facial nerve implantation, using a nerve graft from the leg, and the second involves facial muscle implantation, taken from the thigh. The ultimate goal is to restore a balanced, symmetrical smile on both sides of the face.

Smiling is not just a mechanical lift of the corners of the mouth — it involves the coordination of at least 17 muscles on each side of the face. For most of us, smiling comes naturally. But individuals with facial nerve paralysis or paresis can only smile on the unaffected side, resulting in an asymmetric or “half-smile.”

Facial nerve paralysis causes one-sided facial muscle paralysis, leading to visible asymmetry between the right and left sides of the face. Frequently, the corner of the mouth droops, along with the cheek and eyebrow on the affected side, due to the nerve’s inability to activate the muscles. This impairs the ability to form a full smile and makes social interaction uncomfortable.

The causes of facial nerve paralysis vary: congenital defects, developmental anomalies, trauma (e.g., car accidents), or nerve damage due to viral infections. Although the condition has long been recognized, it wasn’t until about 40 years ago that a surgical solution emerged.

In the 1970s, surgeons began transplanting the patient’s own tissues with their native blood vessels and nerves. By the 1990s, microsurgical techniques enabled the transfer of tissue segments less than 1mm in size, with full functionality — laying the groundwork for successful facial reanimation surgery.

The purpose of facial nerve repair is to restore motion to the paralyzed muscles and enable patients to smile symmetrically again. At the Israel facial paralysis clinic at Tel Aviv Sourasky Medical Center (Ichilov), this is achieved through a two-stage surgical approach.

In the first stage, a nerve is harvested from the leg and implanted beneath the facial skin to connect with the healthy side of the facial nerve. Over the course of eight months, the nerve grows at an average rate of 1 mm per day across to the paralyzed side. Eventually, this graft acts like an “extension cord,” transmitting electrical signals to the non-functional side.

Eight months later, a small muscle from the thigh is implanted on the paralyzed side of the face. The muscle is carefully positioned to match the natural smile trajectory. It is connected to blood vessels for proper circulation and to the previously implanted nerve.

Over the next 4–5 months, the healthy nerve integrates into the implanted muscle. When the healthy side of the face smiles, a signal passes through the reconstructed nerve and activates the new muscle, resulting in a synchronized, bilateral smile.

Today, facial reanimation surgery in Israel has a success rate of 99%. In rare cases (around 1%), complications may arise due to insufficient blood flow or delayed nerve growth. However, even when an initial attempt is unsuccessful, a second operation is typically possible and effective.

If you are seeking facial nerve paralysis treatment in Israel or exploring options for facial nerve reconstruction without waiting, the facial nerve implantation and facial muscle implantation procedures at Ichilov Hospital offer internationally recognized expertise, advanced microsurgery techniques, and compassionate care — with minimal delays in scheduling and treatment.