Our Program

Facial-rev

The facial plastic and reconstructive surgery program at Keck Medicine of USC in Los Angeles is staffed with leaders in facial reconstruction, facial paralysis treatment and aesthetic procedures for the face. Our experts help patients achieve a higher quality of life following facial trauma, certain types of skin cancer and facial nerve paralysis. In addition to complex reconstructive surgeries, the program offers a full range of cosmetic procedures, such as eyelid rejuvenation, forehead lift, chin surgery, ear surgery, nose reshaping, facelift and facial wrinkle treatments.

Renown for our expertise across the full range of procedures for the face and neck, our experts are leaders in reconstructive surgery for treating conditions such as facial paralysis or disfigurement. Patients with weakened or paralyzed faces have access to the entire spectrum of nonsurgical and surgical treatments available, including the extended midface lift and reinnervation surgery, which involves borrowing nerve input from another part of the face or body and plugging it in to start the process of reanimation.

Our team also has extensive expertise in Mohs reconstruction, in which we pair with Keck Medicine of USC dermatology experts in the treatment of skin cancers. Following the resection of the cancer, we are able to reconstruct an area of the face, including a patient’s nose, eyelid or ear.

The USC Facial Nerve Center addresses the specific needs of patients suffering from a variety facial nerve disorders, including Bell’s Palsy, facial paralysis and trigeminal neuralgia, among others.

Our Approach

We offer a patient-centered model of care and deliver treatments with the highest level of compassion. The program is focused on treating patients and critically examining their results.

As pioneers in the field, our surgeons developed the extended midface lift, which has directly improved outcomes for our patients by restoring basic functions such as breathing normally, keeping food in the mouth or shutting the eyes.

Our procedures follow a multi-disciplinary approach, as we work closely with dermatologists, neurologists, physical therapists and speech therapists. Our specialists strive to schedule appointments on the same days our patients may be seeing other practitioners on our Keck Medical Center campus in order to make visits convenien for patients, including those who may be traveling to see us.

Conditions

Aesthetic surgery is designed to improve the appearance of the face. Examples include: face lift surgery, blepharoplasty, rhinoplasty (nose reshaping) and brow lifts. Our facial plastic surgeons focus exclusively on the face. Consultations can include three-dimensional imaging (Vectra™) upon request. We offer consultations on facial rejuvenation surrounding soft tissue filler and botulinum toxin (Botox™) injections. Properly performed facial rejuvenation and aesthetic surgery results in a natural, well-rested appearance.
A deviated septum is a disorder in which the septum (the bone and cartilage that divides the nasal cavity) is displaced making one side smaller than the other. A deviated septum may cause difficulty breathing and may lead to compromised drainage of the sinuses on the deviated side.
Turbinates are long thin bones located on the inside walls of the nose. Allergies may cause turbinates to swell making it difficult for patients to breathe. Large (hypertrophic) inferior turbinates and deviated septum can also contribute to snoring.
Nasal obstruction is the condition where airflow through the nose is insufficient. This can be a life-long condition, or can result after facial injury. Nasal obstruction can cause sleep disturbance, difficulty with exercise and overall it decreases your quality of life. Often nasal surgery that is designed to improve nasal obstruction will also address the external appearance of the nose.
Nasal reconstruction may be required after cancer removal, following traumatic injury to the face, or due to birth defect. As the center of the face, the nose is uniquely important in facial reconstruction. Our specialists are uniquely able to restore form and function to the injured nose. Frequently, the function of the nose follows its form, and restoration of nasal appearance is critical to restoring proper airflow through the nose.
Skin cancer requiring Mohs surgery. Skin cancer is the most common form of cancer, and most frequently develops due to excess sun exposure. The most common skin cancers include:

  • Basal cell carcinoma
  • Squamous cell carcinoma
  • Malignant melanoma
Facial paralysis is the loss of facial muscle movement due to a weakened or damaged facial nerve, usually occurring on one side of a patient’s face. Causes of facial paralysis or facial weakness include trauma to the face or skull, a tumor in the head and neck or a stroke. Facial paralysis may also be congenital. Cases of facial paralysis that are due to tumor removal may be effectively treated by surgery. Facial paralysis is a complex disorder and is treated via a multidisciplinary team at Keck Medicine of USC.
Bell’s palsy is the most common cause of facial paralysis and weakness. It is thought to be due to a viral cause. Approximately 90 percent of patients regain full function in their face with appropriate medical treatment.

The approximate 10 percent of patients do not recover complete function. These patients may benefit from minor surgical procedures that improve their eye function. If you have newly diagnosed Bell’s palsy and would like an urgent evaluation, please request the first available appointment.

Some patients who have had Bell’s palsy may go on to develop synkinesis. This is a condition that causes unwanted contractions of the muscles of the face. It is essentially a “faulty re-wiring” of the facial nerve that occurs after injury and recovery. It can be surprisingly distressing to patients and may impact emotional expression and facial function severely.

Facial trauma is physical injury or wounds to the face. Trauma may involve soft tissue injuries, fractures or wounds to the eye. Facial injuries may lead to disfigurement or loss of function.
Keloid and common scarring are the result of any incision or cut on the face. Keloids are a specific type of scar, in which the collagen grows too abundantly. Both keloids and common scars are very treatable with medical or surgical therapy.
Ear deformities may result from skin cancer, trauma or may be life-long. A significant loss of ear cartilage requires complex reconstruction. Our facial plastic and reconstructive surgeons work closely with dermatologists in the treatment of this disease. Often, Mohs micrographic surgery is recommended in order to remove the skin cancer accurately, leaving behind as much normal skin as possible. Our facial plastic surgeons will perform a reconstruction after dermatology has completed Mohs surgery to remove the skin cancer.

Cosmetic Procedures

Our surgeons are also experts in aesthetic procedures of the face, such as:

Chin surgery (Mentoplasty) or augmentation may be used to balance one’s facial features and help strengthen a person’s profile. This procedure is sometimes paired with rhinoplasty or other facial surgery.
Ear surgery (Otoplasty) is a procedure used to pin back very large ears and may be done under local or general anesthesia. Adults may have this procedure done under local anesthesia. Otoplasty for children and young adults is usually performed under sedation anesthesia. There are incisionless otoplasty treatments available, which can be performed through pin-hole type incisions in the ears without a visible surgical incision.
Eyelid lift (Blepharoplasty) is a procedure used to correct or “lift” droopy eyelids. Droopy eyelids may make patients look older as well as impair vision. This procedure is performed on an outpatient basis. Some facial paralysis and synkinesis patients may benefit from blepharoplasty. Further information is available upon request.
Facelift (Rhytidectomy) is a procedure used to correct wrinkles or sagging skin in the face and neck. This procedure may help restore a younger look. Our surgeons have pioneered innovative facelift techniques, which are designed to rejuvenate your face and highlight your youthful bone structure. Note that many patients with facial paralysis may also benefit from a facelift to improve their facial function as well their facial symmetry. Three-dimensional imaging is available on request to help you understand the effect of a facelift.
Facial wrinkle treatments are procedures typically performed in office settings and are minimally invasive. These treatments include injectable fillers, including botulinum toxin (Botox®), Dysport™ and Xeomin™.
Forehead lift is a procedure used to correct sagging or wrinkles of the forehead and eyebrows. This procedure is usually performed on an outpatient basis. A forehead or brow lift can be performed without any incisions on the face. Using endoscopes in your hairline to visualize the surgical field, our surgeons can elevate the brow without the need for a visible incision. Brow lifts can treat the feeling of “tired eyes” and have been shown to decrease headaches in some patients.
Nose reshaping (Rhinoplasty) is a procedure for patients interested in modifying the appearance of their noses. During this procedure, the nose is repaired or reshaped.
Ear reconstruction is performed to repair ear trauma, skin cancer in the ear or were born with a congenital defect. Our reconstructive surgeons have a unique understanding of the ear’s shape, being able to customize the ear for each individual patient in shape and function. We perform small ear reconstructions after the excision of skin cancer as well as total ear reconstructions due to large defects or a congenital defect in the ear cartilage.

Microvascular facial reconstruction may be used by our surgeons to reconstruct an area of the face using tissue from another part of a patient’s body. This transplanted tissue is known as a free flap. The face may need to be reconstructed in the event of trauma or the excision of cancer. Our surgeons are able to reconstruct any area of the face using microvascular techniques, in which the free flap is connected via tiny blood vessels and fine sutures.

Mohs reconstruction is a reconstructive procedure, in which we pair with Keck Medicine of USC dermatology experts in the treatment of skin cancers. Following the resection of the cancer, we are able to reconstruct any area of the face, including a patient’s nose, eyelid or ear.
Nasal reconstruction is the most common location on the face for skin cancer. The nose has a complex three-dimensional shape of the nose and is positioned on the center of the face. Reconstruction of the nose is a specialty unto itself. Our facial plastic surgeons are highly trained in nasal reconstruction and are sought after for the reconstruction of complex nasal defects.

Nasal reconstruction can involve several surgeries, all performed on an outpatient basis. It is important to understand that the best results in nasal reconstruction are often achieved with several surgeries.

Facial reanimation surgery is used to surgically repair facial paralysis. Patients with facial paralysis are evaluated at the multi-disciplinary facial nerve clinic at Keck Medical Center of USC. We offer evaluation by world famous neurotologists (lateral skull base surgeons), facial plastic surgeons, and physical therapy. Multiple practitioners can coordinate care in a single visit. With our colleagues in neurology, we offer state of the art neuro-diagnostics for accurate testing and prognostic information. Some patients will not require surgery. Others may benefit from a minimally invasive nerve transfer, and the likelihood of success can be increased by performing prompt neurodiagnostic testing.

As a true academic medical center, we offer the full spectrum of surgical options for facial nerve paralysis:

  • Nerve transfer surgery: commonly, the nerve to masseter or the hypoglossal nerve may be transferred and connected to the facial nerve in order to restore the ability to smile or to restore facial tone and symmetry.
  • Temporalis tendon transfer: a muscle that is used to chew food can be repositioned without causing difficulty with chewing. This suspends the corner of your mouth and provides a small amount of movement to the corner of the mouth when you smile. It can be performed as an outpatient and is a minimally invasive procedure.
  • Gracilis free muscle transfer: a muscle from your inner thigh can be disconnected from the leg and reconnected to your face, providing mobile and healthy muscle that restores the ability to smile. This muscle is powered either by a nerve graft taken from your leg, or by a “biting nerve” (nerve to masseter). It is often performed in two stages and it does require a hospital stay after the surgery is complete.
  • Extended midface lift: is a treatment for facial paralysis. The procedure results in directly improved outcomes for our patients by restoring the ability to breathe normally keep food in the mouth or shut the eyes. This procedure lasts longer than a “static sling” and restores balance to a paralyzed face. Please make formatting the same.

Treatments and Services

Three-dimensional imaging such as Vectra® 3D technology allows for preoperative planning in reconstructive and cosmetic procedures. It provides a three-dimensional image of all angles of the head and neck.
Bell’s palsy treatment
Patients with Bell’s palsy may use prescribed eye drops or ointment to avoid dryness of the eye. Your physician may recommend a clear eye patch to protect the eye. When initially diagnosed, patients are usually prescribed oral steroids or an anti-viral medication for about seven to 10 days. Most patients with Bell’s palsy improve with medical therapy alone. We collaborate with dedicated Physical Therapists who can optimize your recovery from Bell’s Palsy.
Septoplasty is a surgical procedure performed to correct a deviated septum that is causing symptoms or blockage. During septoplasty, the cartilage or bone causing the symptoms is relocated or removed. In severe cases of sinusitis with presence of septal deviation, septoplasty is performed alongside sinus surgery.

Synkinesis treatment
Effective treatments for synkinesis include physical therapy. Botulinum toxin (Botox®) or minor surgical procedures may be used to stop involuntary movements. Physical therapy is also a critically important treatment for synkinesis. We work seamlessly with dedicated physical therapists in order to time any necessary treatments accurately, and work together to give you the best possible outcome.

Patient Information

Postoperative Care
The following information is for reference only and should not replace specific instructions given by your physician.

Suture Care

  1. Local anesthesia tends to dissipate within one to three hours after you leave the clinic or the recovery room. If you need pain medication, take with some light food to avoid nausea.
  2. Wound care:
    a) If a pressure dressing (white tape placed firmly over a lump of cotton) has been applied, remove this dressing in 24 hours. You may use rubbing alcohol to help dissolve the adhesive that holds the tape in place. This will protect the skin from having a tape burn. You may then follow instructions below.
    b) Very gently cleanse incision site/suture line with Q-Tips® dipped in hydrogen peroxide on Q-Tips® in a rolling motion to remove any crusting, starting one day after surgery after you remove the dressing. Cleansing the site two to three times a day will promote healing and minimize the final scar. Apply antibiotic ointment, if ordered by your physician, after each peroxide cleansing for the first three days after surgery. Switch to Vaseline® three times daily for the following three days, then stop all ointments on the incision line. Sutures that are blue or black will be removed within seven to 10 days in clinic. Brown sutures are dissolvable and do not need to be removed. Your physician may recommend dressing and ointments to minimize scars following suture removal and would healing.
  3. Personal hygiene, including showering, may be resumed 24 hours after surgery. Do not allow the shower spray to fall directly on the incision line. Blot the area dry gently, and do not rub the towel over the sutures.
  4. A general rule is to avoid sporting activities or lifting items greater than 20 pounds for this period of time for seven to 10 days.
  5. Avoid rapid temperature changes and/or direct sunlight for several weeks. We recommend SPF 30 (or higher) and a hat for the first two months following surgery.
  6. Remember to review your preoperative medication list for medications/herbal products to avoid 10 days before and one week after surgery.

 

Facelift or Browlift

When you get home:
Plan to rest. Sleep with your head elevated on two to three pillows. You may get out of bed to go to the bathroom with assistance. It is normal to be drowsy. Try to eat a light, soft meal the evening following your procedure and avoid excessive chewing. Some swelling, bruising and tightness of the bandage are normal. Take your medication as directed. Call the office immediately if you experience swelling accompanied by increased pain, especially if it occurs only on one side. Drink several glasses of nonalcoholic liquids the first eight hours after surgery. Hydration means voiding a normal amount of urine at least every 6 hours. If you take pain medications, it is best to take it with some food, as it often reduces the side effects of nausea that may be caused by pain medications.

Keeping an ice pack over your cheeks and upper neck will help reduce swelling. An ice pack can be placed on top of a hand towel, and then laid gently on your face. Alternatively, frozen peas or corn work just as well as an ice pack. Most patients attempt to ice for 10 minutes every hour while they are awake. Ice is most effective when used for the first three days after surgery.

At your first visit (usually the day after surgery):
The face dressing will be removed allowing your surgeon to examine your face and all incisions. This dressing will be replaced with a similar dressing after this examination. If a drain was used, it will likely be removed. Eat something light and take your pain pills as needed before coming to the office for the dressing change and other postoperative visits.

Until your second follow-up appointment:
Following your first visit to clinic after surgery, your surgeon will usually ask that you remove the bandages at home the following day (two days after your surgery). Bruising and swelling are expected. Your face will be swollen for two to three weeks after the surgical procedure. After all the bandages are removed, you may wash your face gently with mild soap and water. Avoid vigorous scrubbing. You can now shower and wash your hair with a mild shampoo (e.g., Johnson’s) 1-2 days after your procedure. Do not use a hot hair dryer.

All the sutures/staples will be removed at a second visit that is usually between the fifth and 10th day after your surgery. Please be sure not to place excessive tension on the incision sites for another two weeks after the sutures have been removed. Because alcohol can prolong swelling, avoid it for two weeks after your surgery. Make-up can be applied 2 weeks after surgery. Any color treatments or haircuts should be planned at least three weeks after the procedure. Do not treat your hair within five days before your surgery.

Subsequent follow-up visits in clinic:
Typically, your follow-up visits after surgery will be at the following times: After one day, one to two weeks, one month and three months. Photos will be taken at the three-month visit. Throughout this process, rest (both physical and mental) and adequate nutrition are important factors in healing. Eat well and take it easy for a few weeks. Numbness, tingling, swelling, itching, discoloration, bumpiness, hardness, crusting, tightness and redness around the incisions are normal but temporary. Do not wear earrings or use makeup for two weeks. Avoid sun exposure as much as possible for three months, as it can cause swelling or an uneven change in pigmentation. Wear a hat and sunscreen of at least SPF 30.

Rhinoplasty

When you get home:
Plan to rest. Sleep with your head elevated on 2-3 pillows. Eat light meals that are soft and easy to digest. Moderate bleeding from the nose is normal after rhinoplasty. The gauze dressing taped under your nose will collect the blood and should be changed as needed. Bleeding should decrease over the first 24 hours. You may have bleeding when changing positions quickly.

Keeping an ice pack placed over your eyes will help reduce swelling. An ice pack can be placed on top of a hand towel and placed gently over your eyes. Alternatively, frozen peas or corn work just as well as an ice pack. The ice should not be placed directly over your nasal cast or dressing. Most patients attempt to apply ice for 10 minutes every hour while they are awake. Ice is most effective when used for the first three days after surgery.

The day after surgery:
24 hours after surgery remove the nasal dressing that is taped under your nose. DO NOT remove the nasal cast that is on the bridge of your nose. Notice that the bottom of your nose will have several brown sutures, these can be cleaned with a Q-tip® that is dipped in hydrogen peroxide, starting 24 hours after surgery. Be gentle – you may leave your incisions alone if this is painful or difficult to accomplish. Use saline nasal spray four times a day in each nostril for two weeks after surgery. Lubricate your nostril incision sites (where the sutures are) as directed with Q-tips® and Vaseline® in order to soften hardened crusts.

You may take a warm shower, but very hot showers are to be avoided. Turn your face away from the faucet, and do not let water hit directly on the nasal cast. If you notice any bloody drainage, you may tape a roll of dressing underneath your nose, similar to the dressing you had after recovery.

Note: if you had a turbinate resection, there are separate instructions for this procedure. 24 hours after surgery, you will remove one small dressing that is placed in each nostril.

Until your first follow-up appointment:
It will be difficult to breathe normally through your nose due to internal swelling and the presence of small plastic splints that are secured in your nose to ensure your septum heals well. Swelling tends to be at its peak on the third day after surgery, and starts to subside within one to three weeks. Do not blow your nose or sneeze through it for seven to 10 days. If you sneeze, open your mouth to avoid air being pushed through the nose. Plan to rest for the first week after your procedure. Avoid any physical activities, hard chewing or lifting objects over ten pounds (a gallon of milk is eight pounds). Also avoid bending over for any prolonged period of time, as this will increase blood flow to your nose. This causes throbbing pain, and also increases your risk of having a significant nose bleed. The use of alcohol and tobacco products prolongs swelling and healing and is best avoided for two weeks after surgery. Lubricate your nostril incision sites (where the sutures are) as directed with Q-tips® and Vaseline® in order to soften hardened crusts.

What to do in the event of a nose bleed:
You can expect some light blood-tinged drainage from the nose for several days. If your nose begins to bleed copiously, spray approximately five sprays of Afrin™ (generic name Oxymetazoline HCL 0.05%) into each nostril. Try to relax in order to lower your blood pressure. Sit upright and place a tissue under your nose, but do not compress your nostrils tightly unless absolutely necessary. Allow the Afrin™ at least five minutes to work, and reapply it if there is still bleeding. If the bleeding continues for more than 10 minutes, large clots are expelled from your nose or mouth, or you begin to swallow blood clots, call the office or the on-call physician.

What to do if your cast falls off:
The cast on your nose may fall off, particularly in the shower. If this happens, please call the office and let us know. In the vast majority of cases, the cast can be left off the nose. Rarely, we may have you return to clinic earlier for the cast to be re-applied.

Subsequent follow-up visits in clinic:
In general, additional follow-up visits will be at one week, six weeks, three months (photos will be taken), six months and one year. Eat before coming to the office for your postoperative visits. At one week, the cast will be removed. You may drive yourself to this appointment if you feel up to it. If you normally wear glasses, a protective shield may be provided for you once the cast has been removed. Depending on your rhinoplasty, you may have to avoid using eyeglasses directly on the nasal bones for up to two months. Please ask your surgeon about this at the first clinic visit after your surgery.

Your nose may be swollen and stuffy for several months. Complete healing may take six to 12 months. It is to your advantage to return for all postoperative visits, so that long-term results may be evaluated.

When to returning to normal exercise and sporting activities:
Physical activity can be resumed two weeks after your surgery. Please avoid swimming for a month and diving for two months. We request you not travel by airplane for at least five days after surgery. Do not expose your nose to the sun for four to six weeks. Use a sunscreen (SPF 30 or higher) for one year after surgery. Contact sports may be resumed two months after your surgery, but this depends on the type of surgery you had, so check with your surgeon.

Instructions on Skin Graft Care

  1. Local anesthesia tends to wear off several hours after your procedure. If you need pain medication, please take this medication with some light food to avoid nausea.
  2. Care of your skin graft:
    A) A “bolster dressing” is secured over the skin graft with sutures. These sutures need to be removed in clinic. The bolster is typically made of yellow gauze that is moistened with Vaseline™.
    B) Beginning the morning after surgery, apply Vaseline 2 times daily to the edges of the bolster dressing. This keeps it moist and prevents it from adhering to your skin.
    C) The bolster will be removed at your postoperative appointment.
  3. When to shower: you may shower 24 hours after surgery. Please do not allow the shower spray to fall directly on the dressing. It is helpful to apply Vaseline to the dressing prior to the shower as this repels some water. After your shower, blot the area dry gently with a towel, and do not rub the towel over the sutures.
  4. A general rule is to avoid sporting activities for 7-10 days. Avoid lifting items greater than 20 pounds for 7-10 days. Do not submerge the bolster dressing or your skin graft in water for at least 2 weeks.
  5. Makeup: 2 weeks after surgery you may resume use of makeup and sunblock. At your follow up appointment, your doctor will tell you if makeup needs to be avoided for a longer period of time.
  6. Avoid rapid temperature changes and/or direct sunlight for several weeks. We recommend SPF 30 (or higher) sun block and a hat for the first 3 months following surgery.

Instructions on Incision Care After Forehead Flap Surgery

  1. Local anesthesia tends to wear off several hours after your procedure. If you need pain medication, please take this medication with some light food to avoid nausea.
  2. Care of your incision:
    A) If a pressure dressing has been applied (white tape placed firmly over a lump of cotton), please remove this dressing in 24 hours. You may use rubbing alcohol to help dissolve the adhesive that holds the tape in place. If there is a yellow gauze dressing wrapped around the bridge of skin that connects your nose to your forehead, please DO NOT REMOVE this yellow gauze. It will be removed by your surgeon at a later date..
    B) After removing the white dressings and tape 24 hours after surgery, GENTLY cleanse incision site/suture line with hydrogen peroxide on Q-Tips in a rolling motion to remove any crusting. Cleansing the site 2-3 times a day will promote healing and minimize the final scar. Apply antibiotic ointment after each peroxide cleansing for the first three days after surgery. Switch to Vaseline three times daily for the next three days, then stop all ointments on the incisions. Sutures that are blue or black will be removed within 7-10 days in clinic. Brown sutures are dissolvable and do not need to be removed.
  3. When to shower: you may shower 24 hours after surgery. Please do not allow the shower spray to fall directly on the incision line. Blot the area dry gently with a towel, and do not rub the towel over the sutures.
  4. Avoid any significant physical exertion for 7-10 days. Avoid lifting items greater than 20 pounds for 7-10 days. Do not submerge the incision in water for at least 2 weeks. It is OK to go for a walk on flat ground.
  5. Makeup: 2 weeks after surgery you may resume use of makeup and sunblock. At your follow up appointment, your doctor will tell you if makeup needs to be avoided for a longer period of time.
  6. Avoid rapid temperature changes and/or direct sunlight for several weeks. We recommend SPF 30 (or higher) sun block and a hat for the first 3 months following surgery.

Instructions for treating Bell’s Palsy

In general, Bell’s Palsy affects approximately 50,000 to 70,000 people in the United States every year. The likelihood of a complete recovery is excellent. It is frightening, however, to be unable to move one’s face normally. At your initial consultation, there are a large number of things to discuss. This document gives you some background of what was discussed, and summarizes what to expect as you recover. If you have any questions, please contact our office.

Eye Care:
While you have facial weakness or paralysis, you might not be able to blink normally. Because your eyelid does not properly close, you are at risk for having your eye become dry and irritated. This can be serious, as dryness causes the outer layer of the eye (the cornea), to become damaged. Most of this damage is reversible, but in serious cases it can be permanent. The following interventions may be recommended to you for taking care of your eye:

  1. Use eye drops, such as Akwa tears™ ophthalmic solution, as prescribed by your doctor. This is typically a thin, watery, solution that is applied throughout the day to keep the eye moisturized
  2. Use eye ointment, such as Akwa tears™ ophthalmic ointment. This is a thick ointment, similar to petroleum jelly, which is best used at night before going to sleep. It is difficult to see clearly when this ointment is in place, but it provides important protection for your cornea and should be used at night.
  3. If recommended by your doctor, you may use a clear eye patch (“Moisture Chamber”) to cover the affected eye and protect it. This can be worn during the day, at night, or at all times if you find it necessary to keep your eye free of irritation. You may have been given an eye patch in clinic. If not, you may order an eye patch from Amazon.com, among other online vendors. Please search for “Moisture Chamber” and not eye patch. They should cost no more than $15-20 each.

facial-plastics
What other medications do I take?
When you are first diagnosed with Bell’s Palsy, your doctor likely prescribed oral steroids, such as prednisone. An anti-viral medication may be used as well. These medications are used for about 7-10 days. After this, no new prescriptions are usually needed other than the eye care described above.

Are any additional tests needed?
For some patients, additional testing is helpful. Your physician may have requested electromyography, commonly referred to as an “EMG.” This test is performed by a Neurologist at Keck Hospital, and you will be contacted with an appointment time and further information.

What happens after that?
You will be contacted with the results of the test within several days. For most patients, the results of the EMG are used to provide information about the probability their facial nerve will return to normal. For some patients, the EMG may be used to offer additional treatments that your physician will discuss with you in detail.

When will my face move again?
The vast majority of people recover normal movement of their face. In general, patients who receive appropriate medical therapy (steroids), have a 90 percent chance of making a complete recovery. Even without medical treatment, approximately 70 percent of all patients recover normal facial movement. The difficult part is the wait. It can take up to 12 months to recover complete facial movement. This can be difficult, so please talk to your physician if you are having trouble during this time. t is completely normal to experience distress when half of your face is not moving properly. You have access to many practitioners who can help you with this, and will be glad to do so if asked.

What is synkinesis?
Lastly, after your face recovers movement, you may notice that some parts of your face move even though you are not trying to move them. Commonly, patients will notice that their eye closes when they smile, or that they grimace unintentionally. This is due to your nerve sending “mixed signals” to the muscles of your face, also called synkinesis. There are several effective treatments for synkinesis, including physical therapy. In addition, botulinum toxin injections and minor surgical procedures may be offered if needed. Your physician and therapist will monitor you for signs of synkinesis and will discuss treatment options with you. If you need to contact the USC Department of Physical Therapy for an appointment, please call them at (323) 442-2900. Patients with Bell’s Palsy will usually work with an experienced and licensed therapist who specializes in this area.

Instructions for temporalis tendon transposition surgery

Your surgeon has proposed re-suspending the corner of your mouth through the repositioning of the temporalis muscle and its tendon. In general, this is a safe and well-tolerated procedure.

This surgery will take a muscle that is usually used for biting and chewing, and instead use it to move the corner of your mouth. Because this movement is not natural, there is a significant amount of practice and training that you must do. It is important that you begin exercises to use this muscle before your surgery.

Before surgery: practice using your temporalis muscle
These exercises should be started 1 month prior to surgery if possible. You will do a series of three exercises broken up over the 4 weeks prior to your surgery. Exercise #1 will be done for 2 weeks, you will then do exercise #2 for 1 week, you will then do exercise #3 for 1 week.

To begin, place the palm and fingers of your hand on the side of your head, just above and in front of the ear. Now, firmly press down with your hand, and at the same time firmly clench your jaw or bite down. Do not “snap” your jaw shut, or you may hurt your teeth. Feel the contraction of the temporalis muscle with your fingers and palm while you bite down, then relax. Repeat this cycle of bite down, then relaxing, several times to ensure you can feel the contraction of the muscle. The temporalis muscle is not always easy to feel, so keep trying. For comparison, feel your cheek when you bite down. The large muscle you feel contracting there is the masseter. It is the strongest of the “biting” muscles.

Exercise #1: Using a “bite down” as a means a triggering contraction, contract your temporalis and hold the contraction for a 10 second count. Repeat this 10 times in sequence. This exercise should be done 3 times per day for 2 weeks.

Exercise #2: Practice contracting your temporalis muscle with as little masseter contraction as possible. Your goal in Exercise #2 is to practice contracting your temporalis while minimizing the contraction of your masseter. This requires significant practice but is a critical step to recovering from surgery. Contract your temporalis and hold the contraction for a 10 second count. Repeat this 10 times in sequence. This exercise should be done 3 times per day for 1 week.

Exercise #3: Practice contracting your temporalis muscle with NO masseter contraction. This is difficult. If you find it to be impossible, just repeat exercise #2 for the final week prior to surgery. Contract your temporalis, ideally with no contraction of the masseter muscle, and hold the contraction for a 10 second count. Repeat this 10 times in sequence. This exercise should be done 3 times per day for 1 week.

For example, if your surgery is on June 1st, your regimen would be as follows:

 

Date Exercise
May 1st – May 15th #1
May 16th – May 23rd #2
May 24th – June 1st #3 (or repeat #2)

 

What to expect the day of surgery:
You will have general anesthesia and therefore you cannot eat or drink after midnight the night before your procedure. You will be admitted to the hospital for 1-2 days after your surgery. While in the hospital, the nurses and doctors will take care of your wounds and ensure that you are ready to return home.

When you get home:
You will be instructed when to remove surgical dressings, if any. Once the dressings are removed, you may gently cleanse the incision site/suture line with hydrogen peroxide on Q-Tips in a rolling motion to remove any crusting. Cleansing the site 2-3 times a day will promote healing and minimize the final scar. Apply antibiotic ointment, if ordered by your physician, after each peroxide cleansing for the first three days after surgery. Switch to Vaseline three times daily for the next three days, then stop all ointments on the incision line. Sutures that are blue or black will be removed within 7-10 days in clinic. Brown sutures are dissolvable and do not need to be removed.

Start with light meals that are soft and easy to digest. It is normal to be drowsy, but try to eat a light, soft meal the evening following your procedure. Some swelling, bruising, and tightness are normal. Drink several glasses of nonalcoholic liquids the first 8 hours after surgery. Hydration means voiding a normal amount of urine at least every 6 hours. If you take pain medications, it is best to take it with some food. Food often reduces the side effects of nausea that may be caused by pain medications. Your can resume your normal diet whenever you feel ready to do so.

Keeping an ice pack over your cheeks and upper neck will help reduce swelling. An ice pack can be placed on top of a hand towel, then laid gently on your face. Alternatively, frozen peas or corn work just as well as an ice pack. Most patients attempt to ice for 10 minutes every hour while they are awake. Ice is most effective when used for the first three days after surgery.

Recovery from surgery and early rehabilitation
Once your wounds heal, your surgeon will ask that you resume either Exercise #2 or #3 (see above). You will begin work with Robbin Howard, PT, shortly thereafter. You will have tightness and discomfort in your cheek and mouth area for a few weeks after surgery. It may be difficult to completely open your mouth.

What happens after that?
You will be seen at regular intervals after the initial surgery if you are a resident of the local area. If not, you will have Skype™ consultations with your surgeon and possibly your physical therapist. You will have a detailed routine described for you that will be changed based on your progress after surgery.

When will my face move again?
Temporalis tendon transfer offers excellent suspension of a paralyzed face, with movements that are typically on the order of millimeters. This requires significant training, using the exercises discussed above as well as working closely with your physical therapist. The USC Department of Physical Therapy can be reached at (323) 442-2900.

Resources

American Academy of Facial Plastic and Reconstructive Surgery
www.aafprs.org

American Board of Facial Plastic and Reconstructive Surgery
www.abfprs.org

Facial Paralysis and Bell’s Palsy Foundation
www.facialparalysisfoundation.org

Our Physicians

view profile

Practicing Locations

Keck Hospital of USC
Keck Medicine of USC - Downtown Los Angeles

Specializing In

Rhinoplasty, Face Lift, Hair Restoration Transplant, Eyelid Surgery and Brow Lift, Facial Nerve Reanimation Surgery, Gracilis Free Tissue transfer, Temporalis Tendon Transfer, Nerve Transfer, MOHs reconstruction, Head and Neck Cancer Reconstruction

view profile

Practicing Locations

USC Healthcare Center 4

Specializing In

Extended Midface Lift for Facial Paralysis; Botulinum Toxin for Facial Spasm, Synkinesis and Contralateral Hyperkinesis; Brow Lift and Eyelid Surgery for Facial Dysfunction