Team-based care for facial paralysis, facial weakness and synkinesis in metro Denver area and beyond. 

Your face does a lot of work: it protects your eyes, helps you eat and speak, and shows the people around you how you feel. When the facial nerve is injured, all of that can change at once.

CU Medicine's facial nerve team brings together facial plastic and reconstructive surgeons, otolaryngologists, neurotologists, ophthalmologists and facial rehabilitation therapists. We care for patients at every stage, from a new injury to paralysis that has lasted for years. Every physician on the team is faculty at the University of Colorado Anschutz School of Medicine, so your care reflects current research.

What Is the Facial Nerve?

The facial nerve starts in the brainstem and travels through a narrow bony channel next to the inner ear. It exits the skull just in front of the ear, then splits into branches that fan out across the face. Those branches power the muscles you use to raise your eyebrows, blink, smile, pucker and close your lips.

When the nerve is damaged or stops working normally, part or all of one side of the face can become weak or paralyzed. As some injured nerves heal, they reconnect in a disorganized way, causing tightness or movements you don't intend. This is called synkinesis.

Conditions We Treat

We evaluate and treat facial nerve problems from any cause, including:

• Bell's palsy, especially when recovery is slow or incomplete
• Synkinesis, such as the eye narrowing when you smile, cheek or neck tightness, or facial fatigue
• Ramsay Hunt syndrome, a shingles infection affecting the facial nerve
• Facial weakness after skull base surgery, including removal of a vestibular schwannoma (acoustic neuroma)
• Tumors of the facial nerve or parotid (salivary) gland
• Injury from trauma, a skull fracture or previous surgery
• Facial weakness after head and neck cancer treatment
• Congenital and birth-related facial palsy, including Möbius syndrome
• Other causes, such as stroke, Lyme disease, chronic ear infection, and autoimmune or neurologic disease

Symptoms

Symptoms usually affect one side of the face. They may start suddenly or build slowly over months.

• Forehead and brow: a brow that sits lower or can't be raised
• Eye: trouble closing the eye fully, dryness, burning, excess tearing or blurred vision
• Mouth: a drooping corner of the mouth, drooling, food collecting in the cheek, or trouble with sounds like "p," "b" and "m"
• Nose: a blocked feeling on the weak side when the nostril collapses as you breathe in
• Unwanted movement: tightness, twitching, spasm, or one part of the face moving when you move another
• Other changes: altered taste or sensitivity to loud sounds

Facial paralysis also affects how people feel and connect with others. Many of our patients describe feeling self-conscious, avoiding photos, or withdrawing from social situations. These concerns are a real part of the condition, and we ask about them at every visit.

When to Seek Care

Timing matters. Some treatments work best soon after the nerve stops working; others are designed for long-standing paralysis. Seeing a specialist early keeps the most options open.

• Call 911 if facial weakness comes on suddenly with arm or leg weakness, trouble speaking, confusion or vision loss. These can be signs of a stroke.
• See a doctor within a few days of new facial weakness. For Bell's palsy, medication works best when started early.
• Get prompt eye care if your eye won't close and becomes painful or red, or your vision changes.
• Ask for a referral right away if the nerve was cut or removed during an injury or surgery. Repair is most effective soon afterward.
• Ask for a referral if your face hasn't clearly started to recover within about three to six months, or if weakness gets slowly worse or keeps coming back.

It is never too late to be seen. Even paralysis or synkinesis that has lasted many years can be improved.

Your First Visit

Your first appointment focuses on understanding the cause of your facial weakness, how each part of your face is working, and what matters most to you.

• History. We review how and when symptoms began, past treatments, and any surgery or imaging reports.
• Detailed facial exam. We look at your face at rest and during movement, region by region, and check for synkinesis.
• Eye check. We check how fully your eyelids close and blink, the position of your eyelids and brow, and any dryness, tearing or blurred vision. If you have signs of eye irritation or exposure, we arrange a detailed eye exam with our ophthalmology colleagues.
• Photos, video and grading. Standardized photos, video and facial grading scales let us measure change over time.
• Quality-of-life questionnaires. Short surveys capture how your face affects eating, speaking, comfort and social life.
• More testing if needed. This may include MRI or CT imaging, nerve testing (EMG) or a hearing test.

Most people leave with a plan that combines more than one treatment, often in stages.

What to bring: your medication list, operative and imaging reports, imaging discs, and a few photos of your face from before your symptoms began.

How We Treat Facial Nerve Disorders

Treatment is tailored to the cause of your symptoms, how long they have lasted, and your goals. Many patients never need surgery. Those who do may also benefit from therapy before and after.

Nonsurgical Treatment

• Facial neuromuscular retraining. A therapist trained in facial rehabilitation teaches you exercises, massage and relaxation techniques to improve control, symmetry and comfort. This is the foundation of synkinesis care and supports recovery after surgery.
• Botulinum toxin injections. Small, targeted injections relax overactive or tight muscles in synkinesis and facial spasm. They can also soften the stronger side of the face to improve balance. Effects typically last about three to four months, so injections are repeated.
• Eye protection. Lubricating drops and ointment, nighttime taping and moisture shields keep the eye healthy while the nerve recovers or before surgery.
• Fillers. In selected patients, small amounts of filler can improve lip or brow symmetry without surgery.

Protecting the Eye and Restoring the Upper Face

When the eye can't close, protecting it comes first. Our surgeons work closely with ophthalmology to keep the eye comfortable and preserve vision.

• Eyelid weight. A small gold or platinum weight placed in the upper eyelid helps it close with less effort.
• Lower eyelid tightening (canthoplasty). Tightens and lifts a loose lower eyelid so it sits against the eye and holds tears in place.
• Partial eyelid closure (tarsorrhaphy). Narrows the eye opening, temporarily or long term, when added protection is needed.
• Brow lift. Raises a drooping eyebrow to clear the upper eyelid and improve symmetry.

Restoring Movement (Facial Reanimation)

Facial reanimation surgery aims to bring back movement, most often the smile. The right approach depends on whether the facial nerve can still recover, how long the face has been paralyzed, and your goals.

After reanimation surgery, therapy may help you learn to use your new smile. Results develop gradually over several months as nerves regrow.

Treating Synkinesis

Synkinesis is treated in steps, starting with therapy and adding injections or surgery only when needed. Most patients reach their goals without surgery.

After a facial nerve injury heals, signals meant for one muscle can reach several. You may notice your eye narrowing when you smile, tightness in the cheek or neck, chin dimpling, tearing while eating, or a smile that feels held back. Facial fatigue and discomfort are common. Synkinesis rarely goes away on its own, but it responds well to treatment.

• Facial neuromuscular retraining. A therapist trained in facial rehabilitation guides you through targeted massage, stretching and relaxation, and teaches you to move one part of the face without triggering another. Mirror work and a home exercise program build control over time. Therapy is the foundation of synkinesis care and continues alongside every other step.
• Botulinum toxin injections. Small doses relax the specific muscles that are overactive, often around the eye, chin, cheek and neck. Relaxing these muscles eases tightness and frees up the smile, and it makes therapy more effective. Injections last about three to four months, and we adjust the dose and location at each visit. Small doses on the unaffected side can also improve balance.
• Selective neurectomy. When tightness persists despite therapy and injections, surgery can offer longer-lasting relief. Through an incision hidden in front of the ear, the surgeon uses a nerve stimulator to map each facial nerve branch. Branches that power muscles pulling against the smile are divided, while branches that create the smile are preserved.
• Selective myectomy. Part or all of a specific overactive muscle is removed. Common targets include the muscle that pulls down the corner of the mouth, reached through a small incision inside the lip, and the platysma muscle in the neck.

Your response to botulinum toxin helps us predict which nerves or muscles surgery should address. Selective neurectomy and myectomy are often combined with each other, or with a brow lift or facelift-type procedure, in one operation. Swelling usually settles within a few weeks, and you return to therapy afterward to build on the result. Some patients still benefit from occasional, smaller injections.

Improving Balance and Breathing

These procedures improve symmetry at rest and fine-tune results from other treatments.

• Static suspension (slings). Supportive tissue or material lifts the corner of the mouth and the nostril so the face looks more balanced at rest. Minimally invasive versions use small incisions and shorter recovery.
• Midface lift. Elevates sagging cheek tissue to support the lower eyelid and improve facial balance.
• Lip balancing. Weakening specific muscles on the stronger side of the lower lip, with injections or surgery, can even out the smile.
• Nasal valve repair. Supports a collapsing nostril on the weak side to improve breathing through the nose.

Team-Based Care in One Program

Facial nerve disorders affect the eye, the mouth, hearing, speech and emotional well-being, so no single specialist can address them all. Our team works together to diagnose the cause and coordinate one plan:

• Facial plastic and reconstructive surgeons for nerve repair, reanimation and facial balancing procedures
• Otolaryngologists and neurotologists for ear, skull base and tumor-related causes
• Ophthalmologists for eye protection and eyelid care
• Facial rehabilitation therapists for neuromuscular retraining

When it helps your care, we also work with neurology, head and neck surgical oncology, and behavioral health.

Care for Children

We offer specialized care for infants, children and teens with facial nerve disorders. Children are not small adults: their faces are still growing, and treatment is planned around growth, school and social milestones as well as function.

We care for children with facial weakness present at birth, including Möbius syndrome, developmental facial palsy, birth-related nerve injury and lower lip weakness that shows when a baby cries. We also treat facial weakness that develops later in childhood from Bell's palsy, ear infections, Lyme disease, injury or tumors.

Care for children may include:

• Close monitoring of recovery. Many children with new facial weakness recover well on their own, and regular visits help us track progress and step in early if they don't.
• Eye protection adapted for young children, so the eye stays healthy while they grow.
• Age-appropriate therapy. Facial exercises are built into play and games for younger children and progress to a home program as they get older.
• Smile reanimation surgery, such as nerve transfer or free muscle transfer, timed so a child is old enough to take part in therapy afterward and ideally before school-age social pressures build.
• Treatment for synkinesis and facial balancing procedures as children mature.

Parents and caregivers are part of the team at every step. We coordinate with your child's pediatrician and other specialists, such as audiology, speech therapy and psychology, so your family has one clear plan.

Research

Our faculty, including facial plastic and reconstructive surgeon Eric Wei, MD, study who develops facial nerve disorders, who is able to get treatment, and how treatment changes patients' lives. The goal is to make sure every patient with facial paralysis can reach the right care at the right time. For a list of research publications, please visit the CU Anschutz website. 

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Whether your symptoms began last week or many years ago, our team is here to help you understand your options and support you through each stage of treatment.

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