Facial Reanimation and Facelift for Facial Paralysis
Initially, Jesselyn May didn’t notice her facial paralysis, but photos taken over time revealed a gradual loss of muscle tone, accompanied by sagging on the affected side. “Eventually, my family members pointed it out to me, and as the years progressed, I began to notice it myself,” she says.
Twenty years passed before May was referred to Tang Ho, MD, an assistant professor in the Department of Otorhinolaryngology—Head and Neck Surgery at The University of Texas Medical School at Houston. Fellowship-trained in facial plastic and reconstructive surgery, Dr. Ho recommended facial reanimation using a relatively new dynamic muscle sling procedure – temporalis tendon transfer – accompanied by a facelift to reestablish facial symmetry.
“In patients with facial paralysis, temporalis muscle function is usually intact because the muscle is innervated by the trigeminal nerve and separate from the affected facial nerve,” he says. “In the traditional reanimation procedure a portion of the muscle is reflected down from above and attached to the corner of the mouth to allow patients to move their face and form a smile. The newer procedure involves transferring of the tendinous attachment of the muscle to the mandible to the corner of the mouth, which allows for an orthodromic transfer of force and a more natural smile. Unlike some other facial reanimation procedures temporalis tendon transfer allow the patients to begin smile almost immediately after surgery.”
While May was in the OR at Memorial Hermann-Texas Medical Center, Dr. Ho performed deep-plane facelift procedure as well. By tightening the SMAS layer of connective tissue that lies between the muscles and epidermis, May’s facial features were restored to a more symmetrical and youthful look.
“In most patients with longstanding paralysis, the affected side of the face undergoes essentially an accelerated aging process,” he says. “Without intrinsic innervation to the musculature, there’s nothing to counteract the downward gravitational pull. As a result, the paralyzed side can appear to be 10 to 15 years older than the unaffected side. For these patients facelift is considered part of a comprehensive treatment plan to reestablish facial symmetry.”
Dr. Ho believes that his training in both facial plastic surgery and otorhinolaryngology has enabled him to give his facial cosmetic and reconstructive patients the highest level of care possible. “We spend our entire otorhinolaryngology training focused on the intricate anatomy of the face, head, and neck,” he says. “Subspecialty training in facial plastic and reconstructive surgery further refines our knowledge and facility with this area’s complex anatomy.”
Studies have shown temporalis tendon transfer to be effective in the treatment of longstanding paralysis in conjunction with intense physical therapy. May is currently undergoing rehabilitation to master the use of the right side of her face.
Hospitalized for one night following surgery, she says her overall experience was very good. “I loved everything about Dr. Ho’s interaction with me. He explained the procedures in a way I could understand, and I had the utmost confidence in him.”
Dr. Ho is the core physician for the UT-Houston Facial Plastic & Reconstructive Surgery Program. To refer a patient, please call 713.486.5000.