What is facial reanimation?

Facial reanimation is a term for procedures that help children move their face or make more even movements on both sides of their face.

The nerve that controls the face muscles is called the "facial nerve." One facial nerve comes out of each side of the skull near the ear. These two main nerves divide into many smaller branches that connect to different face muscles:

  • Upper-face nerve branches control the eyebrows and eyelids.
  • Mid-face nerve branches control movements like smiling and chewing.
  • Lower-face nerve branches control the lips.

If the facial nerve or any of its branches does not work, it will affect your child's ability to move the muscles in their face. Those muscles will be paralyzed. This is sometimes called "facial palsy." Facial palsy usually affects only one side of the face. Some children have a condition that affects both of their facial nerves and both sides of their face.

Facial reanimation can be performed at any age. However, there can be some advantages to having the surgery early, including:

  • Eye protection - Facial reanimation can help the eyelids close more tightly. This better protects the eye, minimizes the need for lubricants and drops and reduces the risk of corneal exposure and keratitis, which can lead to blindness.
  • Speech and language development - Evidence shows that when performed at a younger age, smile surgery may benefit a patient's speech and language development and social interactions.

However, smaller patients require special care for the microsurgical part of the surgery. To balance the benefit and challenge of age, facial reanimation is usually done when a child is 4 or 5.

What types of facial reanimation procedures are available?

We offer facial reanimation for children who have paralyzed face muscles involving the eyebrows, eyelids, mid-face and lower lip.

  • Eyebrows: If one eyebrow does not move and the other does, doctors inject Botox into the moving eyebrow to paralyze it. This way, the child's eyebrows match from side to side.
  • Eyelids: If the eyelids don't close tightly, surgeons may place tiny gold weights inside the upper lid to help pull it down. They may use a small piece of tendon to create a sling that pulls the lower eyelid up.
  • Mid-face: If a child cannot smile, surgeons may take a muscle from the child's inner leg (gracilis muscle) and move it to the child's face. They connect one end of this muscle to the cheekbone and the other end to the corner of the mouth. They connect the muscle to working nerves, such as those that help you chew. This procedure is sometimes called "smile surgery." Read about Christian's new smile.
  • Lower lip: If one side of the lower lip does not move and the other does, doctors inject Botox into the moving side to paralyze it, or take the muscle out on the moving side. This makes the lip match from side to side.

What's special about facial reanimation at Seattle Children's?

Seattle Children's Facial Reanimation Program is the only one of its kind for children in the Northwest. We do many types of facial reanimation. Our experienced team and advanced technology help your child recover faster.

Minimally invasive

We use minimally invasive surgical techniques to reduce scarring and help your child recover faster.

During surgery, we access the facial nerve using a small facelift incision.

On the leg, we make a small incision along the inner thigh to remove a short piece of the gracilis muscle. The incision is small enough to be hidden by shorts or a skirt.

Team approach

Each child who comes to Seattle Children's with a facial nerve problem is assessed by a team of providers from many areas of healthcare. This approach - called "interdisciplinary" - helps us learn about your child's condition and provide the best treatment just for them. The team may include pediatricians, surgeons, feeding specialists, speech specialists, therapists, radiologists, nurses, social workers and many others.

The exact team for your child depends on your child's needs. For example, if there's a problem where the facial nerve comes out of the skull near the ear, your child's team may include an ear-nose-throat specialist. If there's a problem with the facial nerve inside the skull, your child's team may include a neurosurgeon.

Coordinated care

We make a care plan that works for your child and your family, working closely together to coordinate care before, after and during surgery. We are there to help your child adapt to changes in their face, like after "smile surgery."

To help plan treatment and check your child's growth and measure treatment results, we use the latest technology, like high-definition video and the 3dMD camera. This camera takes a precise, digital 3-D (three-dimensional) image of your child's face and head.

Who can benefit from facial reanimation?

Any child who cannot move part or all of their face because of a problem with the facial nerve might benefit from facial reanimation. We treat children with many types of conditions, including::

  • Craniofacial microsomia, also called hemifacial microsomia
  • Moebius syndrome, also called congenital facial diplegia
  • Traumatic injury to the facial nerve, such as during birth or from an accident
  • Bell's palsy, in which the facial nerve stops working all of a sudden
  • Facial nerve problems because a tumor near the nerve was removed
  • Other facial nerve problems that children may be born with (congenital) or that may occur later

How does facial reanimation help?

Children who have facial reanimation procedures may enjoy benefits like:

  • Facial expression that matches more closely from side to side
  • Fewer problems with dry eyes or extra tears because their eyelids can close tightly
  • Better ability to eat
  • Better ability to speak clearly
  • Better ability to smile, express their feelings through their face and interact with others

How do I get more information or make an appointment?

A doctor, such as your child's regular pediatrician, can refer you to our program. You can also call us to find out about making an appointment. Call the Craniofacial Center at 206-987-2208.