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Home/Facial Procedures/Facial Palsy

Disorders of the facial nerve are extremely complex and can significantly affect quality of life. London consultant plastic surgeon William Townley is a lead clinician in the Facial Nerve Centre at Guy’s and St. Thomas’. He runs a multidisciplinary team with specialists in ENT, Paediatric Plastic Surgery, Ophthalmology, and Facial Physiotherapy while also sitting on the Medical Advisory Board for the charity Facial Palsy UK. In addition, Mr Townley is a member of the Sir Charles Bell Society, an international organisation of experts from different specialties dedicated to improving outcomes in facial palsy.

William has visited and trained in several international units (Los Angeles, London, Toronto, Boston, Vancouver, and Caen) to learn contemporary techniques and facilitate an innovative approach to his own practice. The facial nerve powers the muscles that are responsible for essential emotional expressions such as smiling as well as basic functions including, eating, speech, and eye closure. Facial nerve injuries can therefore be devastating, both from a functional and aesthetic viewpoint. William offers the full spectrum of facial reanimation treatments to children and adults suffering with facial paralysis from simple chemodenervation techniques (botulinum toxin for synkinesis) to free functional muscle transfer.

There are many causes of facial nerve injury and patients need to be assessed on an individual basis to determine likely prognosis and best course of action. A list of common procedures performed by Mr Townley is listed below. Most procedures require diligent physiotherapy to get the best results.

“Mr Townley is excellent. He is polite professional and down to earth. Made me feel at ease from the moment I met him. Reassured me with every question I ever had and has done an amazing job on making me a new person. I’d highly recommend him to anyone.”


Dynamic Procedures

Listed below are interventions that can restore movement to the affected side of the face by either powering the normal facial muscles or by harvesting the power of other muscles to do a similar job:

Free Muscle Transfer (Gracilis)

The gold standard reconstruction in patients with a long-standing facial paralysis. When powered by a nerve graft connected to the other (‘intact’) side of the face, it gives the best chance of a spontaneous and symmetric smile.

Temporalis Sliding Myoplasty

An increasingly popular technique for restoring the ability to smile. This technique requires intense physiotherapy afterwards to ‘learn’ to smile again. It may be suitable for elderly patients with long-standing facial paralysis who are looking for a simpler operation.

Nerve Transfer or Graft

This approach may be appropriate in patients who have had a recent onset of facial paralysis. It is often performed in conjunction with other procedures such as tumour removal.

Static Procedures

These are a series of interventions that can improve position of the affected side of the face as well as improve function (eye protection, oral control of solids and fluids).

Brow Lift

Facial nerve injuries may result in a droopy eyebrow appearance. A browlift is a relatively simple procedure that can elevate the position of the brow to match the unaffected side.

Fat grafting

Fat transfer is a relatively noninvasive procedure that can help restore contour to the face and improve function eg by supporting flaccid structures such as the eyelid. Mr Townley is a pioneer and expert in fat grafting to the face.

Eyelid protection (oculoplastic surgery)

Simple procedures that can often be done as an outpatient under local anaesthetic to facilitate eye closure and eyelid position. These include:

Static sling to cheek

A simple procedure that can improve the position of the face at rest by using a piece of fibrous sheet to tighten and lift the cheek.


Lower lip asymmetry

Lower lip asymmetry is one of the most common issues in patients with facial nerve weakness. There are several techniques aimed at improving symmetry and function.

Botulinum Toxin (chemodenervation)

BOTOX® may be injected into the affected side of the face to relax facial muscles that have become tight or to reduce unwanted muscle movements. It can also be used on the unaffected side of the face to improve the overall symmetry and appearance.

Come for a consultation to discuss corrective surgery for facial palsy in detail.
020 3124 1373