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University of South Florida

New Facial Nerve Reconstruction Options

Our face makes the first impression on people, reflecting our feelings and emotions. It also holds vital functionality and sensory tools for breathing, seeing, smelling, and eating. Sudden weakness of facial muscles or facial paralysis has many implications in daily activities and social interactions. USF Health has the facial nerve reconstruction surgical options to help you return to your life feeling confident.

Facial paralysis is a condition that is primarily caused by Bell’s palsy, a sudden loss of facial movement, which affects approximately 40,000 Americans each year, according to the National Institutes of Health (NIH). Facial paralysis can also be caused by any surgery that impacts the nerves to the face, including the brain, skin, head, and neck, to name a few, as well as strokes.

Many times, you can regain control of your facial muscles within a short period, but in some cases, you are left searching for the latest care options for facial paralysis.

“We have expanded our offerings to patients who need facial reconstructive surgery. We want to make people aware of the breadth of options we provide to return symmetry to the face,” said Dr. Julia Toman, a physician specializing in Facial Plastics and Reconstruction at the USF Health Department of Otolaryngology.

The Impact of Paralysis on the Face

Facial nerve paralysis is visible by the drooping of muscular features on one or both sides of the face. An asymmetrical smile is typical as well as drooping of the brow and inability to close the eye entirely. There are every day functional aspects of your face that are impacted by paralysis:


  • The collapse of your nasal sidewall, causing trouble breathing.


  • A corner of your lip descending below the lip line can make it difficult to eat and drink.

Eyes and Eyebrows

  • Vision obstruction from your eyebrows descending.
  • Incomplete eye closure causing potential damage to your eye.
  • Your appearance can look and feel tired.

Care Options

USF Health offers a broad range of facial nerve reconstruction surgical options based on your needs and what you are looking to achieve immediately and long term. The goal is to avoid multiple trips to the operating room and provide a comprehensive approach to facial nerve paralysis. Two questions will help define possible treatment options for patients:

  1. Are you looking to return functionality, as well as symmetry to your face?

If you are looking to achieve symmetry at rest in your facial appearance quickly, USF Health provides surgical options to restore overall facial symmetry via facial slings and eyebrow lifts. Static slings don’t provide for the motion of the face but can allow you to look symmetric at rest. Both of these surgical procedures aid in returning vital functionality. Facial slings can help you eat more comfortably with the lip lifted, while brow lifts can help to improve your ability to see and relieve feelings of fatigue.

  1. Would you like to restore the ability to respond emotionally with facial expressions?

One of the major goals is to try and restore a more normal symmetric smile. A surgical procedure to connect a different nerve to the nerve that controls your smile muscle can help you learn to achieve a more natural-looking smile with physical therapy and training.

An additional surgical option in long term paralysis when your smile muscle is weak is to graft a muscle from another part of your body and surgically connect it to alternative nerve connections. Again with physical therapy and time, you can often achieve a more natural movement of the corner of your mouth.

“These procedures do require a lot of commitment from patients because nerves grow slowly, and just connecting the nerve surgically or transplanting a muscle is only half the battle. Patients have to be ready to work with physical therapy to retrain their brains to use the new nerve innervation. It can take over six months to a year to see results, but it is a new exciting option for patients to achieve a natural look,” Dr. Toman said.

Communication to Manage Patient Expectations

“It’s important to have a frank conversation about everything that is involved in facial reconstruction surgery options. Setting expectations for rehabilitation is critical, engaging the patient fully. They need to know everything that is involved after the initial procedure,” Dr. Toman said. “I want patients to feel comfortable with their appearance, so they can continue their full lives feeling great. I treat the entire face holistically for facial paralysis.”

As a facial plastic and reconstructive surgeon, Dr. Toman has rigorous training in Otolaryngology Head and Neck Surgery and additional training in cosmetic and reconstructive surgery. Dr. Toman also has a deep understanding of facial aesthetics, as well as anatomy and function of facial structure. Her extensive highly-specialized training has aided in the development and refinement of her facial nerve reconstruction techniques.

To make an appointment with USF Health’s Otolaryngology (ENT) Facial Plastics and Reconstructive Surgeon, please call (813) 974-4683.

Written By: Kathleen Rogers

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