Facial paralysis explained

Written in association with: Mr Ruben Kannan
Published: | Updated: 03/10/2023
Edited by: Aoife Maguire

Facial palsy is an ailment that affects approximately 25,000 individuals in the UK every year, resulting from a weakness of the facial muscles. We speak to award-winning consultant plastic surgeon Mr Ruben Kannan, who explains the first signs and symptoms and treatment options, including surgery.

 

 

What is facial palsy?

 

Facial palsy typically presents as facial muscle paralysis affecting half the face that comes on suddenly and can last from hours to days. While stroke is one cause of facial palsy, the main cause is Bell’s palsy, usually due to a viral infection. Most cases of facial palsy recover some facial function within six months, however, one-third have long-standing after-effects.

 

What are the signs and symptoms of facial palsy?

 

Patients suffering from facial palsy often complain of long-term tightness around the eye, cheek stiffness, eye-watering, neck tightness and synkinesis (a symptom wherein, for example, when you smile, one eye winks uncontrollably).

 

Unfortunately, these symptoms can worsen over time and have a detrimental impact on both physical and mental health. Recent advances have shown that customised facial therapy can alleviate many of the symptoms effectively.

 

What are the first steps to treat Bell’s palsy?

 

The most essential step towards treating Bell’s palsy is to get oral steroids, within 48 hours of signs showing. Additionally, in some cases, the patient may require antiviral medication, and then seek a specialist, if necessary.

 

What surgery can be used to treat facial palsy?

 

For people with significant facial and neck tightness, a state-of-the-art surgery developed in the US, called selective neurolysis, can be used to reduce synkinetic movements (unwanted contractions of the face during an attempt to move) and recalibrate the face. This is now available in the UK, both via the NHS and privately.

 

Images which I have taken of my patients following the surgery have demonstrated that selective neurolysis can be a powerful tool in relieving symptoms by freeing up the face and alleviating stiffness. It also has the ability to relieve pain in the face and neck. With the appropriate facial rehabilitation regimen following surgery, this can even translate into improved smiles and reduced synkinesis.

 

It must be noted that Bell’s palsy, even in the most severe cases, will show some return of facial movement within six months. If this is not the case, or if the palsy is gradual or only affecting part of the face, you should contact your GP or get a referral to a facial palsy specialist (via Facial Palsy UK) as soon as possible, in order to rule out other causes.

 

 

 

*This article was originally published on the 9th of September 2023 in The Telegraph newspaper.

 

If you are suffering from facial paralysis and would like to book a consultation with Mr Kannan, simply visit his Top Doctors profile today.

By Mr Ruben Kannan
Plastic surgery

Mr Ruben Kannan is an award-winning consultant plastic surgeon, with additional qualifications in head & neck surgery and legal medicine. He is based in East Grinstead (Sussex) and Seven Oaks (Kent) and is recognised as one of the global leaders in the field of facial palsy. After graduating from the prestigious Christian Medical College (CMC), Vellore with a scholarship, he undertook his basic surgical training at the Royal College of Surgeons of Edinburgh and went on to complete on a PhD in Nanotechnology at University College London, where his work contributed to research that led to the world's first synthetic organ transplant. Following his training as a plastic surgeon in the UK, he then completed his advanced training in facial palsy, supermicrosurgery and migraine surgery at the St Andrew’s Centre (UK), Japan and the US respectively. Mr Kannan consults and practices at 7 different clinics and offers different treatments at each specific clinic namely.

Mr Kannan now specialises in facial reanimationsupermicro surgery and Bell's palsy surgery alongside the management of skin cancer and aesthetic surgery. His niche includes surgery for synkinesis (selective neurolysis), pain/secondary migraine management in Bell’s palsy as well as the use of the snail flap to rebuild the scalp without skin graft, thereby preserving hair-bearing scalp during skin cancer surgery. This technique won the best world-wide video article of the premier PRS Global Open journal in 2021, awarded by the American Society of Plastic Surgeons and has revolutionised scalp reconstruction.
 
Mr Kannan practices privately at the McIndoe Centre in East Grinstead, as well as the Amherst Medical and Borough Green Medical Practices, under the auspices of Kent Integrated Dermatology Services (KIDS). His NHS base is the world-famous Queen Victoria Hospital NHS Foundation Trust (QVH] in East Grinstead, where he is part of the largest facial palsy unit in the UK.

Mr Kannan treats the most difficult and complex Bell's palsy cases in the country and is a strong proponent that early treatment in Bell’s palsy leads to better outcomes. In 2018, he jointly performed the world's first free functioning muscle transfer for chewing function at QVH. His clinical work has also been published in numerous peer-reviewed journals and he is regularly invited to share his work both on the national and international stages. Mr Kannan also has numerous awards and prizes to his name such as the joint winner of the International Microsurgery Club’s best-case competition as well as being a twice finalist at the World Society of Reconstructive Microsurgery Best Case competitions in 2019 and 2021.  While he has built an impressive career so far, he continues to push the boundaries for the betterment of his patients. He is also an accredited member of the Sir Charles Bell Society (Facial Palsy), World Society of Reconstructive Microsurgery (WSRM), American Society of Reconstructive Microsurgery (ASRM) and the British Lymphology Society (BLS).

Mr Kannan's leadership qualities are also reflected in his roles in various public organisations. He is a medical advisory board member for Facial Palsy UK, founder and member of the UK Cranial Nerve Network and expert on the International Microsurgery Club's panel, while also a council member of the plastic surgery section of the Royal Society of Medicine. In addition, he runs the McLaughlin Prize and Fellowship programmes at QVH, East Grinstead with trainees coming from the world over as well as the prestigious TIG fellowship in head & neck surgery for UK trainees. As per his expertise, Mr Kannan functions as a professional expert witness for medico-legal cases relating to facial nerve injuries after accidents and surgery.

Mr Kannan is able to perform symmetrising facelifts with the use of High-SMAS deep-plane plication facelifts with the FAME modification, tailor-tack sutures, as well as structural fat grafting, which are powerful tools in rebalancing the face following facial palsy. Mr Kannan has done hundreds of facial palsy surgeries and is one of the leading experts in the world on this subject. Please find an example of this approach in the photo gallery, wherein there was significant mid-facial ptosis, malar festoons and jaws pre-op. These are aptly corrected using these surgical strategies.

Consultations are available at the McIndoe Centre in East Grinstead, please email [email protected].

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