Facial paralysis is the loss of voluntary muscle movement on one or both sides of the face, caused by injury or dysfunction of the facial nerve. The most common cause is Bell’s palsy — a temporary condition that resolves on its own in most patients. Other causes include acoustic neuroma (a benign tumor near the ear), parotid gland tumors, trauma, stroke, infection (such as Ramsay Hunt syndrome), and congenital conditions like Möbius syndrome. Each cause requires a different treatment approach, which is why seeing a specialist with broad experience across all types is important.

This is one of the most important questions to answer early. Temporary (reversible) paralysis means the facial nerve and muscles are still intact and capable of recovery — treatment focuses on protecting the nerve and supporting natural healing. Permanent (irreversible) paralysis means the facial muscles have lost their nerve supply and have begun to atrophy — treatment focuses on transferring new muscles or nerves to restore movement. Diagnostic testing including EMG (electromyography) can help determine which category applies to you. Dr. Kochhar performs this evaluation as part of every new patient consultation.

You should seek a specialist consultation if: your facial paralysis has not shown improvement after 3 months; you have been told your paralysis may be permanent; you are experiencing synkinesis (involuntary facial movements); you are having difficulty closing your eye completely; or you want to explore surgical options for restoring facial movement. Earlier evaluation generally leads to better outcomes — many surgical options are most effective when performed within a certain window of time from the nerve injury.

Synkinesis is an abnormal pattern of facial movement that can develop after facial nerve injury — for example, your eye involuntarily closes when you try to smile, or your neck tightens when you blink. It occurs when nerve fibers regrow in disorganized patterns. Treatment options include targeted Botox injections to quiet the overactive muscles, specialized facial physical therapy with neuromuscular retraining, and in some cases surgical intervention. Dr. Kochhar develops an individualized treatment plan for every synkinesis patient based on which areas are most affected.

The right surgical approach depends on how long you’ve had paralysis, whether your facial muscles are still functional, and your personal goals. Options include nerve grafting (repairing the facial nerve directly), nerve transfer procedures (using a nearby nerve such as the masseter or hypoglossal nerve to power the facial muscles), temporalis tendon transfer (a minimally invasive procedure to restore smile movement), and gracilis free flap surgery (the gold standard for restoring a spontaneous, synchronized smile in patients with irreversible paralysis). Static procedures — which improve symmetry and appearance without creating movement — are also frequently used in combination with dynamic procedures.

The gracilis free flap is widely considered the gold standard procedure for restoring dynamic, synchronized smile movement in patients with irreversible facial paralysis. It involves transferring a small muscle from the inner thigh — along with its blood supply and nerve — to the face, where it is connected to blood vessels and nerves to power a new smile. The procedure requires microsurgical expertise. Not every patient is a candidate — the best outcomes are generally seen in patients whose facial muscles are no longer functional and who are in good overall health. Dr. Kochhar will determine whether this procedure is appropriate for you during your evaluation.

Eye protection is the most urgent priority for any patient who cannot fully close their eye. Inability to close the eye completely puts the cornea at risk of dryness, abrasion, and infection that can lead to permanent vision loss. Dr. Kochhar recommends all such patients use preservative-free artificial tears frequently throughout the day, lubricating eye ointment at night, moisture chambers or protective eyewear, and taping the eye closed during sleep. Surgical options for longer-term protection include platinum weight placement in the upper eyelid and lower eyelid repositioning procedures.

In many cases, yes — particularly for reconstructive procedures performed to restore function following a documented medical cause such as tumor removal, trauma, or a neurological condition. Coverage varies significantly by insurance plan and the specific procedure. Dr. Kochhar’s team will help you understand your insurance benefits and navigate the prior authorization process. Cash-pay options and financing are also available.

Recovery timelines vary significantly depending on the procedure. Static procedures typically have recovery periods of 1–2 weeks. Nerve transfer procedures involve a waiting period of several months before new nerve function begins to appear, with continued improvement over 12–18 months. Gracilis free flap surgery involves an initial hospital stay of a few days, followed by weeks of healing and then months of neuromuscular retraining with a physical therapist. Dr. Kochhar will give you a realistic timeline specific to your planned procedure during your consultation.

You can reach our office by phone at (310) 477-5558 or submit a consultation request through our contact page. Dr. Kochhar sees new facial paralysis patients from across Los Angeles, the greater Southern California region, and the western United States. Telemedicine consultations are available for patients traveling from out of state who would like an initial evaluation before visiting Los Angeles in person.