Patients affected by facial palsy often have facial asymmetry at rest, and asymmetry with motions such as smiling. There are two main types of static suspension procedures: fascia lata suspension (done in operating room) and in-office suture suspension. The static suspension procedure using fascia lata creates improved resting facial symmetry of the corner of the mouth, nasolabial fold (a.k.a. laugh lines, smile lines), philtrum (vertical indentation in the middle of the upper lip), and base of the nose. The suture based suspension creates an improved resting nasolabial fold only. While the procedure does not restore motion to the side affected by facial palsy, they often improves symptoms such as drooling, nasal blockage, and biting the inner cheek and lip.
The static suspension procedure using fascia lata is performed under general anesthesia and takes roughly 90 minutes. Patients may stay one night in the hospital and go home the next morning. To perform the procedure, we make two one-inch incisions on the outside of the thigh to harvest a piece of tensor fascia lata (TFL), a thick band of tissue which is excellent for suspending the facial tissues, and has an extremely low risk of infection and other complications since it is the patient’s own (autologous) tissue. There are minimal side effects from removing this tissue from the thigh. We then make a facelift incision in front of the ear and stitch the fascia into the proper position around the mouth in order to resuspend the corner of the mouth, upper lip, laugh line, and base of the nostril. We then close the incisions and place two small drains, one in the leg and one in the face. These drains will be removed the next morning before discharge. Patients will have absorbable stitches in the face, which typically dissolve around the 14-21 day mark after surgery.
The in-office suture suspension is performed in the clinic with local anesthesia and takes about 60-90 minutes. A one inch incision is made in the temporal hair line and tiny nicks are made in the intended nasolabial fold. Permanent sutures are then threaded from the nasolabial fold to the temporal region to suspend the midface. Patients go home the same day and do not have any drains. Sutures are absorbable, and typically dissolve completely by around the 3 week post-surgery mark.
After both procedures, patients may experience mild to moderate discomfort, which usually resolves after 2-3 days. Patients are able to walk around and eat a regular diet after surgery. We do ask that patients avoid heavy lifting and strenuous activity for 2 weeks after surgery. Occasionally, minor wound issues develop (fluid in the leg donor site [OR based operation only], redness or leaking of one of the incisions), which a most often easily resolved in the office.