What is a static sling?

Diagram of fascia lata anatomy of thigh.Static sling is a procedure that involves taking a piece of tissue taken from the thigh, called fascia lata, and placed into the face to resuspend the mouth and cheek. It is a rather old technique but effective if you want to simply keep the corner of the mouth elevated at rest. It can be combined with a number of other procedures, such as a facelift for facial paralysis, to maximize results. The effect of gravity in facial paralysis can advance the timetable on sagging of facial skin. The static sling can add another layer of suspension to counteract this effect to maintain suspension of tissues over a longer period of time.

 

When is a static sling used?

Fascia lata used in static sling procedure for facial paralysis.In most patients, dynamic options such as muscle and nerve transfers are available and preferred. However, in some individuals who have other health problems, the added operative time needed to perform these procedures may be too much to handle. The static sling is a last option in Dr. Panossian's practice because there are better options available that will accomplish elevation of the lower face at rest and with muscle activity. Static options, in general, are never as good as dynamic ones, due to the inability to provide motion.

Before and after of a woman after static sling procedure for facial paralysis.

 

What is the recovery like?

Recovery from a static sling procedure is relatively straightforward. Incisions on the face and thigh will need to heal simultaneously. Although walking after surgery is allowed, you must not engage in aggressive physical activities or weight bearing for at least 6 weeks. You will wrap the thigh with a compression ACE wrap during this time for comfort and swelling control.

The facial incision may have a small drain for approximately 24 hours after surgery to prevent any fluid collection underneath the skin. This is removed in the office very easily. Antibiotics are used for a short period of time.

Pain is minimal following surgery. Patients occasionally mention some soreness in the thigh or discomfort from swelling in the cheek. Most swelling subsides in 1-2 weeks.

 

What are the risks and complications of static sling surgery?

If you are considering the static sling as option for reconstruction, you must understand that the procedure does NOT result in the return of muscle activity or facial expression to the face. It simply elevates a drooping cheek or mouth at rest. There are minimal risks associated with a static sling procedure. As with any other surgery, there is a small chance of bleeding, infection, or anesthesia issues. Usually, the greatest risk is that the sling may loosen over time. This is usually the result of a number of factors, including the unrelenting forces of gravity, postoperative trauma or infection, or other co-morbidities such as diabetes, smoking, or steroid use. Fortunately, correcting this issue is relatively easy, but does require a short subsequent outpatient surgery to tighten the sling. The more common issue is that certain asymmetries can persist in the relaxed state or with animation. These can be minor or more substantial. 

Complications of surgery can include hematoma in the first few days, requiring drainage in the operating room. Infection of the cheek can require a brief hospitalization for intravenous antibiotics and/or surgical drainage.