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South Carolina’s Only Facial Reanimation Team Offers Hope for Paralysis Relief

Advance With MUSC Health
May 23, 2023
Doctor examining patients thyroid

Facial paralysis is one of the most complex areas of reconstructive surgery because of the wide variety of functional and cosmetic deficits. These range from the facial droop seen in Bell’s palsy, which may require simple monitoring and facial exercises, to complete paralysis, which will require surgery on muscles and/or nerves.

Facial paralysis is most commonly caused by Bell’s palsy1, but etiologies also include congenital paralysis, tumors, trauma, or idiopathic or iatrogenic causes.

Medical interventions

Facial reanimation, the improvement of facial movement and quality of life, is the specialty of Michelle Hwang, M.D., assistant professor, Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology – Head and Neck Surgery at MUSC Health. She and other facial plastic and reconstructive surgeons offer treatments that can make facial expression possible. MUSC Health’s facial reanimation clinic is the only one in South Carolina.

“The most common condition I see is synkinesis, which is incomplete facial paralysis,” says Dr. Hwang. “Approximately twenty percent of patients with Bell’s palsy have synkinesis.”

For other patients with varying degrees of paralysis, treatment can be a combination of pharmacologic therapy, physical therapy, or surgical intervention.

MUSC Health’s multidisciplinary facial reanimation team comprises facial plastic and reconstructive surgeons Dr. Hwang, Dr. Krishna Patel, and Dr. Judith Skoner; Sarah Murphy, a physical therapist trained in facial rehabilitation, and psychologists. 

Advanced surgical procedures

Many medical and surgical options exist for the treatment of facial paralysis. Often, surgery will work on increasing the size and movement of the smile. Options that improve eye closure also are available.

MUSC Health surgeons offer the following techniques:

  1. Gracilis free flap – a microsurgical procedure that transfers part of a gracilis muscle from the leg to the paralyzed area of the face.
  2. Nerve transfers, such as the masseter-to-facial nerve transfer for smile restoration.
  3. Temporalis tendon transfer, which seeks to achieve dynamic movement of the paralyzed side of the face so that it is as symmetric as possible with the normal side.
  4. Selective neurectomy or myotomies to address synkinesis.
  5. Static sling – a procedure that places thigh tissue into the face to resuspend the mouth and cheek, which keeps the corner of the mouth elevated when the patient’s face is at rest.

Prompt evaluation is important

The nature and duration of lost nerve function determines the therapeutic approach. Acute facial paralysis is less than 3 weeks’ duration. Intermediate duration facial paralysis is 3 weeks to 2 years. Chronic facial paralysis is more than 2 years.

“When you’re coming toward that year or two, you start to see atrophy of the facial muscles because they haven’t been stimulated,” says Dr. Hwang. In that case, the muscles have lost the ability to move.

Dr. Hwang emphasizes that timely treatment is important. “It’s never too early to refer a facial paralysis patient to us because, even if it’s too early for surgical treatment, we can get the patient plugged into our range of non-surgical treatments.”

To refer a patient to the facial reanimation clinic at MUSC Health, please visit Dr. Hwang's profile page or call 843-792-3531.


1. Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;122:4–30. doi:10.1080/000164802760370736