During an appointment with a facial plastic surgeon, patients often request that the surgeon make them look like a celebrity. Thanks to her full lips and high cheekbones, Angelina Jolie is a favorite among young women seeking to make improvements to their faces.
It’s important to realize, however, that the celebrities we see in movies, TV, the internet, and magazines don’t always have the glamorous lives we imagine. Despite their beautiful features, their talent, and their wealth, they still deal with many of the same problems that we do.
Earlier this year, Angelina Jolie spoke to the magazine Vanity Fair about a problem that affected those very features that so many girls and women idealize. She had an episode of partial facial paralysis, otherwise known as Bell’s palsy, that caused one side of her face to droop. Not only does Bell’s palsy lead to an asymmetrical face, it can also cause difficulties with chewing, talking, smiling, and breathing.
Jolie isn’t the only celebrity who’s suffered the discomfort and embarrassment of Bell’s palsy: George Clooney, Roseanne Barr, and Ralph Nader also had episodes of the nerve condition at one point or another.
What Is Bell’s Palsy?
Bell’s palsy is benign but disfiguring facial paralysis that occurs when one of the two facial nerves that carry signals to the muscles of the face becomes inflamed. When the nerve is swollen, it can’t transmit signals from the brain to the facial muscles that allow them to move. The muscles become stiff and droopy. The affected eye may have trouble blinking and/or producing protective tears. Because the mouth is affected, you may even drool. One of George Clooney’s first symptoms, as a teen, was a protruding tongue.
What Causes Bell’s Palsy?
The exact cause of the neural inflammation that causes Bell’s palsy is unknown. The condition may be at least partially genetic; if someone in your family had it, you have a greater chance of developing it, too. Emotional or physical stress may be a factor, too. Jolie conjectures that the turmoil of her divorce and cancer scares may have triggered her episode. Ralph Nader developed partial facial paralysis after his older brother died of prostate cancer.
Most researchers suspect that facial nerve paralysis can also be triggered by a viral infection. Infections that sometimes precede or accompany Bell’s palsy include:
- Herpes simplex (cold sores or genital herpes)
- Herpes zoster (chicken pox or shingles)
- Mononucleosis (Epstein Barr)
- Rubella (measles) or mumps
- Influenza B (flu)
- Coxsackievirus (Hand-foot-and-mouth disease)
How Can I Tell If I Have Facial Paralysis?
The onset of Bell’s palsy tends to be very sudden. It can range from mild to total paralysis of one side of your face within hours to days. Rarely, it will affect both sides of your face.
Facial nerve paralysis shares many of the same symptoms of a stroke, such as:
- Rapid facial paralysis
- A drooping face
- Feeling of stiffness or pulling on one side of your face
- Trouble making expressions
- Pain around jaw or ear
- Loss of your sense of taste
- Decrease or increase in tears and/or saliva
- Increased sensitivity to sound on the affected side of your face
If you develop symptoms that seem like Bell’s palsy, you must seek immediate medical care — you may be having a stroke. Facial nerve paralysis is a diagnosis of exclusion, which means that serious conditions must be ruled out first.
How Long Does the Paralysis Last?
After you’ve been diagnosed with Bell’s palsy by a facial paralysis expert, the good news is that 85% of cases resolve completely without treatment — most within days to months. In fact, when Roseanne Barr had facial nerve paralysis at the age of three it went away with just time working its magic.
About 10% of patients will have some residual weakness and paralysis. Only 5% go on to develop synkinesis —a condition in which the facial nerve, leading to unwanted muscle contractions or the loss of some muscle control. Learn more about synkinesis at Wikipedia.org.
Can Botox Help Me Regain Control of My Face?
Even though facial nerve paralysis itself is not a serious condition, facial nerve paralysis can be embarrassing and uncomfortable — particularly if it lasts for more than a few days. Depending on which muscles are affected, you could also be at risk for complications. It is most important with patients with facial paralysis to protect their eye. During facial paralysis, the eye may not close completely. This can lead to an ulcer on the eye and effect the vision. Patients with new onset facial paralysis should be seen urgently by an ophthalmologist and using drops to keep their eyes lubricated. Patient should be using ointment in their eye to keep it lubricated while they sleep.
The clenched facial muscles in synkinesis can be relaxed with injections of the neuromodulators Botox, Dysport, or Xeomin — but this an advanced procedure that must be performed by a facial plastic surgeon or another facial synkinesis expert. This can improve facial symmetry at rest and during animation.
Will I Need Surgery for Bell’s Palsy?
Bell’s palsy is a temporary condition that does not typically require surgery. However, as mentioned above, in a small percentage of patients, the paralysis may not resolve.
Facial paralysis can be treated with surgical procedures, such as:
Temporalis Transfer: The temporalis muscle is transferred from the scalp to the mouth corner, restoring the patient’s ability to chew and make normal facial movements.
Hypoglossal-Facial Nerve Jump Graft: The nerve that moves the tongue is grafted onto the facial muscles, allowing them to animate again.
Gracilis Free Flap Transfer: The gracilis muscle, along with its corresponding nerve, artery and vein, is removed from the inner thigh and is transferred to the face, where it may be attached to the masseter nerve or another nerve branch. This procedure takes several surgeries over the course of two years and is most appropriate for younger patients.
Call an Expert to Treat Facial Nerve Paralysis
If you are frustrated by your facial synkinesis and want to reclaim your facial symmetry, as Jolie, Barr, and Nader have, contact us at Carolina Facial Plastics, in Charlotte, NC. Jonathan Kulbersh, MD, is a double-board certified facial plastic surgeon and facial synkinesis expert who was trained by one of the country’s premiere facial paralysis surgeons. Dr. Kulbersh’s knowledge and experience let him create customized facial paralysis treatment options for his patients. If you suspect you may have facial synkinesis, call our office or contact us today with our online form.