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Facial nerve palsy

What is facial nerve palsy?

Facial nerve palsy occurs when the facial nerve — which controls the muscles of facial expression — becomes weak or paralysed. This can affect one side of the face (unilateral) or, in very rare cases, both sides. People with facial palsy may find it difficult to close their eye, smile symmetrically, or move part of their face. The condition can affect appearance, comfort, and confidence — especially when it involves the eyelids.

Miss Ting is an oculoplastic surgeon with experience in managing the functional and cosmetic aspects of facial nerve palsy, particularly when the eye and eyelids are affected.

 

What Causes Facial Nerve Palsy?

There are many potential causes, including:

  • Bell’s palsy (most common, often temporary and without a known cause)

  • Infections such as Lyme disease or shingles

  • Trauma or surgery affecting the facial nerve

  • Tumours or structural problems affecting the nerve’s pathway

  • Stroke (although this usually spares forehead movement)

 

Early Phase: Observation and Supportive Care

In many cases — particularly with Bell’s palsy — the facial nerve can recover partially or fully over time. Because of this, watchful waiting is often the best initial approach. During this period, the focus is on protecting the eye, especially if the eyelid does not close properly.

Miss Ting may recommend:

  • Lubricating eye drops or ointment

  • An eye shield at night to prevent dryness or damage

  • Taping the eyelid shut while sleeping

  • Referral to a facial physiotherapist

For self-guided exercises and support, patients can visit the UK-based Facial Palsy UK website: www.facialpalsy.org.uk

This resource offers videos, exercises, and information on rehabilitation and recovery.

 

Long-Term Management and Treatment Options

If nerve function does not return fully, there are a number of surgical options that can help improve comfort, symmetry, and eyelid closure. Miss Ting offers a personalised approach depending on the degree and location of weakness, especially around the eye.

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Treatments include:

Gold or Platinum Weight Implantation

  • A small weight is surgically inserted into the upper eyelid

  • This helps the eyelid close more naturally using gravity

  • The implant is discreet and usually well-tolerated

  • This is often the most effective way to protect the eye in long-term facial palsy

 

Lower Eyelid Tightening or Support Surgery

  • If the lower lid is drooping or sagging, surgical support can help restore a better lid position

  • This improves comfort, reduces tearing, and protects the eye surface

 

Botulinum Toxin (Botox®) Injections

  • In some cases, small amounts of botulinum toxin can help rebalance facial asymmetry by weakening overactive muscles on the unaffected side

 

Brow and Forehead Adjustments

  • If eyebrow droop is contributing to visual field problems or asymmetry, a brow lift or similar procedure may be considered

 

Compassionate, Specialist Care

Living with facial palsy can be challenging — both physically and emotionally. Miss Ting offers specialist oculoplastic care focused on restoring eyelid function, protecting vision, and supporting facial balance and confidence. Whether a temporary condition or a long-standing problem, she takes the time to assess each case carefully and work with you to plan the most appropriate course of treatment.

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Next Steps

If you or a loved one has facial nerve palsy and are concerned about eye closure, tearing, or appearance, Miss Ting can help. Please get in touch to arrange a consultation.

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