Facial Reanimation in Los Angeles, CA

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Facial reanimation is a surgery that is designed to restore the ability to express oneself when nerve damage prevents normal facial movement. Andre Panossian, MD Plastic Surgery in Pasadena, CA provides specialized facial reanimation treatments to help patients feel happier and more confident in their everyday lives.

(626) 765-6885

Facial Reanimation Explained

Though it is sometimes called “smile surgery” or “smile animation” for its ability to help patients express their happiness with a smile once again, facial reanimation offers more benefits than just renewing this single expression. Using different techniques, Dr. Panossian can improve or restore function to the eyelids, allowing them to blink and close; allow the eyebrows to raise and lower; and recreate or improve symmetry of the face. 

Realistic facial movements often involve the full face, so Dr. Panossian seeks to restore the area as a whole. Nerve issues in the face can also cause pain and uncomfortable sensations known as facial nerve neuropathy, which can be reduced or eliminated in some patients with surgery.

Facial Reanimation Before-and-After Photo Gallery

Facial Reanimation: How Nerve Damage Occurs

Patients may be born with or develop nerve damage for several different reasons. The most common requests for surgeries are due to disease, injury, and issues present at birth. The seventh cranial nerve controls all the muscles involved in facial expressions, and any issues with its functionality can cause a facial-wide effect. 

Tumor Growth

Head and neck cancers, as well as their subsequent treatments, can affect the network of facial nerves that originate from the seventh cranial nerve. These growths occur due to uncontrolled cell division that results in tumors, or a mass of diseased cells. 

In some cases, the cancerous growth may have originated in the brain, face, or neck, while other times it may have metastasized, or spread, to the area from elsewhere. The tumor may have caused damage on its own, and some treatments directly target the cancer cells but may not be able to spare all surrounding tissue.

Bell’s Palsy

A sudden onset of facial paralysis or weakness in one half of the face, known as Bell’s palsy, may be related to the common herpes viruses that cause lesions like cold sores and chickenpox. While doctors and medical scientists do not understand the exact link, there is not typically a related health concern. 

The changes to the facial muscles affected after the nerve has become damaged are often temporary. Though it is rare, Bell’s palsy can lead to long-term issues with facial nerve functionality, requiring facial reanimation surgery.


Injuries to the face often create visible damage, and in some cases, the more extensive the impact can also affect the underlying tissues. Cell repair to these networks is both slow and insufficient, and surgical intervention may be necessary. In some patients, a traumatic brain injury may have affected the muscles and nerves of the face.

Traumatic injuries may also create cosmetic issues. Because Dr. Panossian specializes in plastic surgery, he can treat damage caused by these injuries to improve aesthetics.

Congenital Abnormality

There may not always be a known underlying cause of facial nerve issues when patients are born with abnormalities like Moebius syndrome, which causes weakness or paralysis in different cranial nerves. This can lead to difficulty in making facial movements or expressions. Treatment can sometimes lead to improved functionality of the facial features.

Treatments for Effects of Facial Paralysis

Symmetry Procedures Before and After Photos in Pasadena, CA, Patient 8634

Surgery for Facial Reanimation

Dr. Panossian provides various treatment options for patients who come to his Pasadena office for smile reanimation. The surgeon can repurpose nerves through rerouting and grafting, provide an alternate source for facial movement with muscles, and perform early and late interventions, both of which can be successful. 

In addition to these types of procedures, the doctor also specializes in plastic surgery techniques to improve his patients’ smiles. Facial nerve repair surgery may require a multidisciplinary approach for the best results.

Muscle Surgery

Temporalis Myoplasty

A relatively new procedure that has been performed for the last 20 years is the lengthening of the temporalis myoplasty. During the procedure, the temporalis muscle, which is located near the temple and used when making biting and clenching motions, can be altered to help move the corners of the mouth, aiding in smiling. The procedure rotates the muscle so it can perform additional functions.

Gracilis Muscle Transplant

A gracilis muscle transplant is performed by harvesting a portion of the inner thigh muscle for transplant to the site of the facial paralysis. With its nerves and blood vessels, the tissues can be connected to the masseter nerve for movement of the lips. This surgery does not impact the movement of the donor’s leg.

Temporalis Flap Procedures

The temporalis flap is also commonly involved in reconstruction due to its versatility. The muscle is located near both the eyes and mouth, making it an ideal option to correct issues affecting these features. Reconstructive procedures may also involve the temporalis flap. 

During a temporalis transfer, a section of the tendon is attached from the muscle to the corner of the mouth, creating dynamic movement. The procedure is considered minimally invasive, and the superficial temporal fascia is spared, which can also be repurposed during a smile reanimation procedure.

Nerve Surgery

Selective Neurolysis

Selective neurolysis for synkinesis or “mass movement” is a treatment for synkinesis, which is the involuntary movement of the face during facial movements. This can occur after an episode of Bell’s palsy and may last indefinitely. 

During selective neurolysis, abnormal nerve pathways are treated during surgery of the muscle or nerves by removing defective portions of these structures, or with Botox injections. These treatments should be followed up with the appropriate facial physical therapy regimen to ensure the most effective treatment of synkinesis.

Facial Nerve Grafts and Nerve Transfers

When one side of the face is affected by nerve damage but the other side retains normal nerve function, a cross facial nerve graft (also called a facial nerve graft) can be performed. 

This surgery transfers nerve action to the non-feeling side of the face through a graft of the sural nerve of the lower leg. The procedure can be effective in both early and late facial paralysis. When multiple nerves are grafted, sometimes called a “cable nerve graft,” different areas of the face may be affected.

Nerve transfers provide a similar type of treatment. Healthy facial nerves are transferred to areas of damage to rehabilitate the affected nerve. A masseter-to-facial nerve transfer can assist with smiling abilities.

Cosmetic Procedures

The most popular non-surgical treatment for wrinkles is Botox injections. The purified neurotoxin paralyzes facial muscles by affecting the transmission of nerve signals, leading to more relaxed expressions that do not create facial lines. When treating asymmetry caused by facial paralysis, Botox injections can be used on the unaffected side of the face to create a natural-looking balance.

In other cases, different plastic surgeries can be performed to surgically alter the tissues of the face when muscle movement and nerve activity cause facial drooping. Dr. Panossian routinely performs the following: 

  • Facelift
  • Eyelid surgery
  • Brow lift
  • Correction of facial asymmetry
  • Static sling (suspends the cheek and mouth)

Cosmetic procedures often complement facial reanimation treatments, especially when the patient has experienced trauma. 

Candidates for Facial Reanimation Treatment

Dr. Panossian is an expert in craniofacial and reconstructive surgery. He is a preferred surgeon in the Los Angeles area for pediatric care related to facial deformities and paralysis. Patients or parents of children who need procedures like facial reanimation can contact Andre Panossian, MD Plastic Surgery to book a consultation. Some general criteria for Dr. Panossian’s patients include:

  • Good general health
  • Operable concerns
  • Good prognosis following treatment

The Facial Reanimation Consultation

When a patient arrives for a facial reanimation assessment in Pasadena with Dr. Panossian, there will be paperwork to complete and discuss as well as a physical assessment of the areas of the face requiring treatment.

If the patient has not received a diagnosis, Dr. Panossian may be able to determine where the issues originate, as he is a facial nerve specialist. In other cases, patients may be referred for treatment by another specialty physician, like a neurologist.

Dr. Panossian may request records of common procedures like nerve studies and imaging to ensure he has a full understanding of existing damage before creating a treatment plan.

Facial Reanimation Before-and-After Photo Gallery


Potential Side Effects and Risks of Facial Reanimation Treatment

Dr. Panossian can review any potential risks and concerns with patients during their Los Angeles facial reanimation consultation. Facial reanimation requires surgery of the muscles and nerves, which are two important structures of the face that control its movement. 

There is a risk of further damage to these two main components and the chance that existing damage will persist. Patients may notice sensations or numbness for a short time after the procedure, or indefinitely. Any surgery carries a risk of bleeding, swelling, blood clots, medication reactions, and adverse effects. 

Dr Andre Panossian is one of the most gifted doctors I know. He is an exceptionally, wonderful doctor but it’s not just that. He is an amazing person!!! He has a wonderful, kind, bedside manner that puts you at ease. He truly cares about his patients and it shows through is love. He literally saved my life last year not just physically but emotionally. I recommend him very highly to anybody and everyone!!! Thank you for everything, love you!!!

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Frequently Asked Questions About Facial Reanimation

What causes the inability to smile?

The patients who visit Dr. Panossian for smile reanimation treatment have nerve or muscle damage in their face that affects the movement of their mouth, causing facial paralysis. Nerve cell messages travel to the muscles, which causes movement. If either structure is impacted, basic movements like smiling may not be possible.

What is the difference between facial reanimation and smile reanimation?

The terms are synonymous. When someone smiles, it is not just the lips that move. The cheeks raise and the outer eyes crease. Most facial structures are involved in this most basic facial movement. It is common for different areas of the face to be affected by facial paralysis; blinking, moving the eyebrows, and frowning may not be possible, either.

What is the difference between treatments for facial paralysis and smile reanimation?

Because facial paralysis often leads to the inability to move areas of the face, the treatments are similar. Facial paralysis treatment may include different cosmetic surgeries to permanently lift areas of the face when nerve function cannot be improved, whereas facial reanimation focuses on restoring movement, so patients can move their faces voluntarily.

Why is some nerve damage permanent?

When nerves are damaged, the connection between neurons and the muscles can be impacted during and after the damage occurs. Nerves heal very slowly, and regeneration can be difficult for the body to accomplish because healing signals are complicated. Some nerve damage requires surgical intervention, and if a patient delays treatment, nerve damage may be permanent.

How is facial reanimation performed?

There are numerous ways to improve the voluntary movement of the face or create a natural-looking resting face. Dr. Panossian may perform surgery involving the muscles and nerves, use lifting techniques, or treat the face through a repeated series of Botox injections. 

Newer nerve injuries often require different treatment plans than addressing the damage that occurred in the past. Some patients may respond well to more conservative methods that are non-surgical and minimally invasive. Others might require a more extensive treatment plan, requiring one or more surgeries.

About Dr. Panossian

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Andre Panossian, MD, has a Pasadena, CA practice dedicated to procedures that improve patients’ lives. The surgeon skillfully operates on both adults and children and strives to help his patients live comfortable and normal lives. Dr. Panossian is known around the world for his innovative methods used during surgery.

Facial reanimation is fulfilling work for Dr. Panossian because it allows him to help his patients express themselves. The treatment is often performed to address the result of a disease process or injury, as a lack of facial mobility can remind patients of a difficult time in their lives. Smile reanimation also helps Dr. Panossian’s patients interact normally with others. Aside from improving a patient’s mental health, certain operations can restore sensation to an area of the face, or improve pain and discomfort.

Contact Andre Panossian, MD Plastic Surgery to schedule a facial reanimation consultation in Los Angeles at 626-765-6885 or complete the Contact Us form.

Last modified by Dr. Andre Panossian

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