Suture Cheek Suspension Augments Periorbital Aesthetic Rehabilitation in Facial Nerve Palsy

Purpose: Facial nerve palsy may lead to significant functional facial and ocular morbidity. Soft tissue resuspension may improve both functional and aesthetic defects. We have adapted a minimally invasive midface suspension, which may be easily combined with routine paretic periocular rehabilitation to optimize outcomes. Methods: A retrospective review of patients with unilateral facial nerve palsy who underwent midcheek release and suture suspension simultaneous with periocular surgical rehabilitation at 2 surgical centers was performed. A temporal incision was made and dissection carried along the deep temporalis fascia to the lateral orbital rim. Dissection was continued subperiosteally along the anterior face of the maxilla to the piriform aperture. In severe cases, a second incision via superior buccal sulcus was utilized to maximize cheek soft tissue mobilization. Through 3 separate stab incisions along the nasolabial fold each end of a 0-0 permanent braided suture on a Keith needle was used to engage and elevate cheek soft tissues, secured at the deep temporalis fascia. Results: Seven patients (mean age 69 years) with unilateral facial nerve palsy and symptomatic facial droop underwent midface suture suspension simultaneous to eyelid reconstruction. With an average follow-up of 8.7 months, all patients demonstrated lasting improvement in facial asymmetry and reported satisfaction with their results. There were no significant postoperative complications. Conclusions: Midfacial static soft tissue resuspension is an effective minimally invasive surgical option for static facial rehabilitation in patients with facial nerve paralysis that can be performed at the time of periocular rehabilitation to enhance functional and aesthetic outcomes.