Facial Paralysis After Surgery

The facial nerve (seventh cranial nerve) has a central role in facial movement, tear production, special senses such as taste, control and reduction of noise, and several other functions. Any surgery performed near the facial nerve may result in an injury that leads to facial paralysis. Patients may experience complete or partial facial paralysis immediately or soon after surgery.

An innovator and thought leader in the area of facial paralysis, Dr. Shai Rozen and a highly specialized group of leading neurotologists, neurosurgeons, and facial nerve physical therapists at the University of Texas Southwestern Medical Center have helped restore facial function, appearance, and balance for many people with facial paralysis in the journey to recovery, improved self-image, and confidence. If you or a loved one has had facial paralysis after surgery for longer than 3 months, it’s important to see a facial nerve surgeon to discuss treatment options.

Facial Paralysis After Surgery
 Before & After Photos

Case: 1 of 2
Before and 3 years after a dually innervated free functional gracilis muscle transplant for smile reanimation.
Before and 3 years after a dually innervated free functional gracilis muscle transplant for smile reanimation.
Case: 1 of 1

Smile restoration with a dually innervated free muscle transplant performed by Dr. Shai Rozen in Dallas, Texas. Patient presented with left facial paralysis several years after removal of a facial nerve tumor. She had difficulty with smiling, facial asymmetry, speech, and eating. 3 years after surgery, patient has an improved smile, improved... Read More

Keep in mind that each patient is unique and your results may vary.

Which types of surgery can injure the facial nerve?

Surgeries for tumors of the parotid, tumors of the skull base, and tumors of the facial nerve may pose some risk for the facial nerve. Certain facial plastic surgery procedures may also result in facial nerve injury. It’s important to discuss the risk for facial nerve injury prior to surgery.

Surgery for which types of tumor may affect the facial nerve?

Common tumors that may affect the facial nerve include:

  • Malignant (cancerous) tumors of the parotid
  • Malignant tumors in proximity to the facial nerve
  • Benign tumors that grow close to the facial nerve such as acoustic neuromas which most often rise from the vestibular portion of the cochlear nerve
  • Tumors of the facial nerve itself, such as facial nerve schwannomas and hemangiomas

Does the type, size, or location of a tumor increase the risk for facial paralysis?

The risk for facial paralysis varies significantly between benign and malignant tumors.

Benign Tumors

Benign tumors generally entail a lower risk of injury to the facial nerve since, in most cases, they are not incorporated into the nerve and can be separated from the nerve with minimal to no injury. There is an increased risk for facial nerve injury when a benign tumor is:

  • Very large
  • Very close to the facial nerve
  • Arises from the facial nerve

Sometimes in cases of very large benign tumors, the surgeon deliberately leaves some of the tumor behind to avoid injuring the facial nerve. The surgeon may choose to follow the patient for a few years after surgery to assess if the tumor is enlarging. Sometimes radiation is offered to suppress the remaining tumor.

Malignant Tumors

Malignant tumors in the area of the facial nerve are different. Some malignant tumors tend to incorporate the facial nerve, and some have a high affinity to the nerve. These are situations in which the surgeon may need to sacrifice the facial nerve in order to provide the patient with a better overall prognosis and often to save their life. 

Dr. Rozen in scrubs posing in the operating room
Facial Paralysis Surgeon

Dr. Shai Rozen

Dr. Rozen is a board-certified plastic surgeon who co-created a facial paralysis specialty group with colleagues from otolaryngology & neurosurgery at the University of Texas Southwestern Medical Center.

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How can surgery damage the facial nerve?

There are several ways the facial nerve can be injured during surgery, including:

Intentional Resection

When removing a tumor that is very large, arises from the facial nerve, or is malignant, the surgeon may choose to electively resect the nerve, sometimes saving the patient’s life. When treating facial paralysis after intentional resection, it is very important for the facial nerve surgeon to know if reconstruction with a nerve graft was attempted, a nerve gap was left, or repair was impossible at the time of surgery. In centers of excellence such as at UTSW Medical Center, these surgeries for tumor removal are often done in a multispecialty setting in collaboration with Dr. Rozen, often optimizing results and patient outcomes.


In certain cases of cancerous tumors or very large benign tumors, the entire tumor is successfully removed, but the patient wakes from surgery with paralysis, or paralysis occurs a couple of days after surgery. If some motion was seen immediately after surgery and the patient loses function days later, it indicates the nerve is intact but postoperative swelling compressed the nerve. In this case, patients usually receive steroids, and the nerve often recovers partially or completely.

Unintentional Trauma

The nerve may have been strongly retracted (pulled) during surgery, inadvertently partially or completely cut, or burned. In these cases, patients may wake up with facial paralysis, but if the nerve is intact (in continuity), there is a chance for varying degrees of recovery.

When To See a Specialist

If facial nerve paralysis occurs after surgery and persists for longer than 3 months, it is advised to see a surgeon like Dr. Rozen, who specializes in facial nerve reconstruction, and discuss possible future options.

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Can radiation after surgery affect the facial nerve?

As previously noted, sometimes radiation is needed after surgical removal of a tumor (postoperative radiation). Before undergoing radiation, the patient should discuss with their treating tumor surgeon the reasons and the risks for radiation therapy. A good conversation between the patient and the surgeon who removes the tumor is necessary for understanding the risks versus benefits of radiation instead of or after surgery.

In some cases, postoperative radiation can further weaken the facial nerve and cause complete or near-complete paralysis. Today’s radiation therapy is very advanced and often allows extremely accurate radiation targeting, which minimizes the number of necessary doses and injury to the facial nerve.

Can facial nerve paralysis occur after facial plastic surgery?

Although not common, the facial nerve may be injured during an elective facial plastic surgery procedure such as a facelift or even liposuction of the neck. If, during surgery, the surgeon recognizes the inadvertent nerve injury, immediate nerve repair during the surgery yields the best results.

In cases when patients wake up from surgery with facial weakness, most patients will recover. If patients wake up with complete paralysis, close monitoring of any facial motion over the next is permitted, but consultation with a facial nerve surgeon may be advisable after a couple of months if no recovery is observed. Early communication and close collaboration with a facial nerve surgeon is important and helps both the patient and the facial nerve surgeon decide whether to choose observation or surgery.

A Valuable Resource for Those Affected by Facial Paralysis

If you, a loved one, or a patient is affected by facial paralysis, it’s crucial to have accurate, up-to-date information about symptoms and solutions. Board-certified plastic surgeon Dr. Shai Rozen, a specialist in facial paralysis and facial aesthetics, created Your Guide to Facial Paralysis & Bell’s Palsy to be a readily accessible resource for all.

This downloadable, printable e-book makes it easy to understand:

  • How paralysis affects the face
  • When it’s time to see a specialist
  • Common causes of facial paralysis
  • The difference between facial paralysis and Bell’s palsy
  • Myths and facts
  • The latest treatment options
  • Answers to common questions

Get your free copy today—to download or view in your web browser—by completing the following fields:

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Your Guide to Facial Paralysis & Bell's Palsy

What if my surgeon tells me to wait for 1 or 2 years to see if the facial nerve recovers?

Many patients who experience facial paralysis after surgery are told to wait a year or 2. It is very likely that the surgeon has the patient’s best interests in mind, and waiting is often beneficial since some nerve injuries are transient and temporary. With this in mind, if no motion is observed in 3 to 6 months, it is advisable to seek consultation with a surgeon with in-depth knowledge of facial paralysis.

The advantage of early communication is that it provides you with an opportunity to establish rapport with your surgeon and team. A thorough discussion and exam help determine the type, location, and possible degree of injury and also provide you with peace of mind and a better understanding of the treatment strategy prior to any future interventions if needed.

So, in summary, what should I do if I have facial paralysis after surgery?

If you know that the facial nerve was deliberately cut during surgery in order to remove a tumor, you should consult with an expert facial nerve surgeon sooner rather than later, usually within the first 3 months of surgery. In places with organized multidisciplinary teams such as Dr. Rozen and his colleagues from neurotology, neurosurgery patients will very often meet with Dr. Rozen prior to tumor extirpation, and surgery will involve all teams to optimize results.

If you or your surgeon are not sure whether the facial nerve was completely cut or if other types of injuries are suspected, such as nerve traction injury, thermal (heat) injury, or a partial nerve cut, you can wait for 3 months to see if any function is regained. If no function is observed, it is best to consult with an expert facial nerve surgeon.

Next Steps

Facial paralysis after surgery can be a devastating experience. Dr. Shai Rozen and his team have extensive experience with facial paralysis and facial nerve surgery using advanced techniques to repair damage to the facial nerve and help patients in the journey to restore function and appearance. Request a consultation to meet with Dr. Rozen at UT Southwestern.