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Home » Reconstructive Surgery » Facial Paralysis

Facial Paralysis – Facial Reanimation

Facial Paralysis Surgery New York

Facial Paralysis Surgery – Bells Palsy – Facial Reanimation

FACIAL PARALYSIS SURGERY/ BELLS PALSY/ FACIAL REANIMATION | NYC
Facial Anatomy

Facial Nerve Paralysis. Damage to the facial nerve may cause an imbalance of the face at rest as well as distorted, asymmetrical facial expressions (e.g. smiling, laughing, grimacing, etc.). Functionally, facial nerve injury affects chewing, fluid retention while drinking, nasal breathing, corneal exposure, speech patterns, and communication skills. In children, facial paralysis most commonly occurs developmentally at birth or after brain tumor resection. Adults may experience complete or partial paralysis following an episode of Bell’s Palsy, acoustic neuroma, or traumatic injury.

At rest, the loss of facial muscle tone causes downward droopiness of the brow, eyelid, nostril, lip, and cheek on the paralyzed side of the face. The functional loss of the dynamic muscles of the lip and cheek results in abnormal lip and oral function affecting chewing, retaining fluid while drinking, speech patterns, and communication skills. Weakness of the circular muscles around the eye causes incomplete eye closure (lagophthalmos), excessive corneal exposure and tearing. Paralysis of the small nasal muscles causes a collapse of the nostrils during breathing.

In the upper third of the face patients will be unable to wrinkle one side of their forehead. and the brow drops over the eye often blocking vision. For this type of problem, Dr. Jacono does a brow lift. Often we do an endoscopic forehead lift.

The brow lift tends to reposition the droopy eyebrow and droopy forehead at a more even position with the other side often improving vision.


Facial Paralysis Surgery Patient 1: This patient had right-sided facial paralysis (left side of the picture) after the removal of a right side facial tumor for cancer that caused her brow to droop over her eye and limited her ability to close her eye. This caused her eye to dry and blocked her vision. She underwent a browlift and a right upper eyelid gold weight implantation.

Before
Facial Paralysis - Patient 1 - Before
After
Facial Paralysis - Patient 1 - After


Rather than elevating one side of the brow another option is to use Botox and even the two brows. If there isn’t too much sagging of the upper eyelid tissue that is blocking the vision on the injured side then the other side can be paralyzed temporarily with Botox (botulinum toxin) to match the injured side.

The most important concern Dr. Jacono has with facial paralysis is the functional protective actions of our facial muscles. Without the blink reflex and the ability to close the eye the cornea can become dried out and injured from exposure. This can significantly damage vision. A gold weight can be placed in the upper eyelid through a blepharoplasty (eyelid surgery) incision. With a gold weight, when you rest your eyelids the weight will close the eyelid for you. Since a different nerve opens the eye the ability to open the eye is still present. We use gold because it is very dense and non-reactive.

Perhaps the most devastating loss is the ability to smile. This is especially heartbreaking to younger patients and their families who are embarrassed by the loss of communication skills and whose self-esteem is severely impacted by peer criticism. In the lower third of the face, the mouth and cheeks sag. The mouth must be able to close in order to talk, prevent drooling, whistle, pucker, and open in order to communicate, smile, display emotion, etc. Dr. Jacono uses a variety of methods for repairing facial nerve paralysis around the mouth. In one stage regional muscle transfers from the adjacent scalp or neck are used to balance voluntary facial expression and restore a more even smile. The active method of doing this is to transfer a muscle from the chewing muscles of the side of the face down to help elevate the corner of the mouth. The newest most revolutionary procedure for this today is the Temporalis Tendon Transfer Procedure which transfers a small tendon from the muscle used to chew to help the corner of the mouth move. This is all done through a small incision inside the mouth so that there are no scars.


Facial Paralysis Surgery Patient 2: This patient had right sided facial paralysis (left side of the picture) from a bell’s palsy. Reconstructive surgery with a temporalis tendon transfer surgery. Notice the better balance of the mouth after surgery.

Before
Facial Paralysis - Patient 2 - Before
After
Facial Paralysis - Patient 2 - After


Other times Doctor Jacono uses cross facial nerve grafts ( nerves harvested from an inconspicuous donor site on the calf) to “splice” into selected branches of the facial nerve on the normal side of the face. These grafts serve as a conduit for the growth of the “electrical wiring” to the paralyzed side of the face. In cases of a recent injury, the re-innervated muscles are reawakened by the ingrowth of the new nerves. In long-standing cases of total facial paralysis, a second stage procedure is used to microsurgically transfer a fresh muscle from the inner thigh to replace the paralyzed smile muscle and receive the nerve impulse from the cross facial nerve graft. Outcomes are not entirely predictable, but in almost all cases facial balance and symmetry is restored by the static re-suspension and a substantial degree of voluntary smile activity and facial expression is achieved.

Drooping of the cheeks is addressed with an endoscopic midface lift and a dropped jawline is addressed with a facelift and neck lift.

A More Symmetrical Face. Although there are no absolute guarantees, these procedures have been very successful in restoring facial balance and a more symmetrical facial expression to dozens of patients who have come here from all over the country and the world. As you might expect, these procedures enhance the “quality of life” for children and adults alike. Facial expression, function, and communication skills that we all take for granted are dramatically improved!

Reconstructive Surgery

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Dr. Jacono was selected as one of the Top Ten Facial Plastic Surgeons in New York.
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Andrew Jacono, MD, FACS has been honored with the Patient’s Choice Award for the 7th year in a row. 2012 - 2018
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Dr. Jacono has launched a new Middle Eastern Facial Plastic Surgery version of his website for Middle Eastern Facial Plastic Surgery

Doctor Jacono performs Charitable Surgery for Children with Cleft Lip and Palate on Missions to Third World Countries and also on Women who are Victims of Domestic Violence. … Best Plastic Surgeon

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Mission Statement

Doctor Jacono’s desire to become a facial plastic surgeon was solidified in grade school. There was a girl on his school bus route who was born with a cleft lip and palate deformity. Unfortunately, whenever she spoke, air and words escaped through her nose. Kids teased her and were cruel, and nobody would sit next to her on the bus, so he decided to sit with her. One day, the girl had plastic surgery and returned to school with her face repaired. Suddenly, classmates saw her face instead of her deformity and immediately treated her normally. It was at that moment that Doctor Jacono knew he wanted to fix people’s faces and change their lives. This is why he has gone on over twenty plastic surgery missions to poor countries around the world and provided free cleft lip and surgery for birth defects to over 500 children.

Because of this experience in his childhood, Doctor Jacono understands that one of our basic needs as human beings is to feel confident about our appearance. It’s is Doctor Jacono’s passion to help his patients achieve their facial aesthetic goals, creating natural appearing results to either enhance their beauty and proportion or rejuvenate their aging appearance. He is a world-renowned leader in the field of facial plastic surgery and only performs surgery on the face, not the body. He has innovated many facelift, eyelid lift, and rhinoplasty surgical techniques, publishing in leading peer reviewed literature and lecturing at plastic surgery conferences all over the world. He is committed to sharing what he has learned teaching surgeons from around the world.

His approach is to maintain your uniqueness and facial identity; it is still you just better. To do this he uses a customized, bespoke approach to each patient employing the most minimally invasive, innovative, and cutting-edge technology. Doctor Jacono has never performed the same procedure on any two of the thousands of patients he has treated. He is committed to providing his surgical expertise in a caring, supportive environment with a professional staff that has you as their focus and concern.