Specialist facial palsy · UK Facial Palsy Centres
Facial reanimation surgery, at a UK Facial Palsy Centre.
Nerve grafts and transfers, gracilis free-flap smile reanimation, eyelid weights and static procedures — planned by an MDT at one of a handful of UK centres where facial reanimation is what the team does every week.
Why patients choose us
- 01
The right centre, not the nearest one
Facial reanimation is done well in only a handful of UK units. We point you to a Facial Palsy Centre where this is what the team does every week — not once a year.
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MDT from the first conversation
Plastic surgeon, ENT, ophthalmologist and specialist speech-language therapist — planning your surgery together, not in silos.
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Realistic, not oversold
A spontaneous emotional smile in every patient is not the honest promise. We tell you what the evidence actually says before you commit.
Indicative pricing
What facial reanimation surgery costs privately in the UK.
Indicative per-stage ranges at UK Facial Palsy Centres. A full plan usually combines several stages over 2–3 years, and most patients have a large NHS component alongside self-pay or insurance.
In short
A gracilis free-flap for smile reanimation: £25,000–£40,000, then 12–24 months of rehabilitation.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Consultation and MDT assessment | £350–£600 | 60–90 min | Same visit |
| Upper lid platinum/gold weight (lagophthalmos) | £3,500–£6,500 | 45–60 min LA | Day case |
| Lower lid tightening (tarsal strip, canthoplasty) | £3,000–£5,500 | 60 min | Day case |
| Static sling to modiolus (fascia lata or GORE-TEX) | £6,000–£10,000 | 90–120 min | 1 night |
| Cross-face nerve graft (sural donor) | £12,000–£18,000 | 4–6 hours GA | 1–2 nights |
| Nerve transfer (masseter or hypoglossal to facial) | £10,000–£16,000 | 3–5 hours GA | 1–2 nights |
| Gracilis free-flap (single-stage, masseter-driven) | £25,000–£40,000 | 8–10 hours | ITU 24h + 5–7 nights |
| Temporalis transfer (Labbé lengthening myoplasty) | £15,000–£22,000 | 4–5 hours | 2–3 nights |
| Contralateral Botox for symmetry | £350–£600 | 15 min | Same visit |
Prices vary by centre, by the surgeon leading the case, by ITU length of stay for microsurgical stages, and by how many stages your plan needs. We come back with a firm quote — and a clear NHS-vs-private split — within one working day.
The problem
The right centre, the right stage, the right expectations.
Facial reanimation is done well in only a handful of UK units, and it is easy to be routed to a generalist plastic surgeon by mistake. We fix that route, we get the timing right, and we set the expectations honestly.
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Not sure it is time yet?
For Bell’s palsy under six months, surgery is rarely first choice. We say so — and arrange the neurology or ENT review that actually helps.
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Worried about the eye?
A dry, exposed cornea is the priority. An eyelid weight is a small, reversible operation that protects sight while longer-term plans are made.
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Want the best possible smile?
A named plastic or facial-plastic surgeon at a UK Facial Palsy Centre — with ophthalmology and SLT already in the room.
The journey
From enquiry to rehabilitation — what happens, in order.
One coordinator from first message through every stage of a 2–3 year plan — including the rehabilitation.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · Admission and surgery
Day-case to ITU, depending on stage
Phase 3 · Rehabilitation
12–24 months, specialist SLT + physio
- 01
Before
You tell us what happened
A short, confidential form. Cause of the palsy, when it started, House-Brackmann or Sunnybrook grade if you have it, previous surgery or radiotherapy.
- 02
Before
We route you to a specialist MDT
Within one working day: a named plastic or facial-plastic surgeon at a UK Facial Palsy Centre, with the ophthalmology and SLT support already lined up.
- 03
Before
Assessment and planning
House-Brackmann grading, Sunnybrook scoring, photographs and video, EMG or ENoG where relevant, and an MRI of the facial nerve if needed. A staged plan is drawn up.
- 04
Admission
Admission for the surgical stage
Arrival, consent and marking with the surgeon and anaesthetist. Free-flap stages spend 24 hours in ITU; static and eyelid procedures are shorter admissions.
- 05
Admission
The procedure itself
From a 60-minute eyelid weight under LA to an 8–10 hour microsurgical gracilis free-flap under GA — the technique matches the stage and the goal.
- 06
Admission
Recovery on the ward
Free flaps are monitored hourly for 48 hours. Static and eyelid work goes home within one to two days with clear wound-care instructions.
- 07
After
Rehabilitation over 12–24 months
Specialist SLT and physiotherapy for biofeedback and neuromuscular retraining. Nerve growth is slow — visible movement typically starts 6–9 months after reinnervation.
Typical end-to-end: 6–12 weeks from enquiry to first surgical stage. Full rehabilitation: 12–24 months.
When it helps
When facial reanimation surgery is the right step.
The causes we see most, plus the one red flag that means same-week ophthalmology rather than a routine referral.
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Bell’s palsy that did not recover
Most cases recover within six months. When movement has not returned by then, permanent weakness is likely and reanimation planning begins.
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Ramsay Hunt syndrome (VZV)
Herpes zoster of the geniculate ganglion often leaves worse residual weakness than Bell’s — earlier surgical referral is common.
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Acoustic neuroma or skull base surgery
Facial nerve injury after vestibular schwannoma or other posterior fossa resections — often known about at the time of the original operation.
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Temporal bone fracture or trauma
Direct transection or crush injury of the facial nerve after head injury, gunshot or penetrating trauma — timing is critical.
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Iatrogenic (parotidectomy, mastoid)
Facial nerve injury after parotid, middle-ear or skull-base surgery — the specialist centre can plan a graft or transfer.
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Congenital (Möbius, hemifacial microsomia)
Children and adults born without a functioning facial nerve — free-flap reanimation is the mainstay in specialist paediatric-adult centres.
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Synkinesis after partial recovery
Unwanted co-movement — the eye closing when the mouth moves — after incomplete nerve recovery. Botox, physiotherapy and selective myectomy help.
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Red flag: exposed cornea
A dry, red or ulcerating eye from lagophthalmos is sight-threatening — same-week ophthalmology, not a routine waiting list.
Procedure options
One operation is rarely the whole plan.
A working reanimation usually combines a dynamic procedure, a static procedure and eye protection. Here is what each option actually involves.
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Direct nerve repair or cable graft
Best within 12 months of injury while the distal nerve and muscle are still viable. A sural or great auricular nerve is used to bridge the gap.
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Cross-face nerve graft
A sural graft tunnelled from the healthy side’s buccal branches to the paralysed side. Two-stage — the graft grows for 9–12 months before the second stage.
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Nerve transfer (masseter or hypoglossal)
The masseter or partial hypoglossal nerve is rerouted into the facial nerve for faster reinnervation than a cross-face graft, but the smile is not spontaneous.
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Gracilis free-flap (functioning muscle)
A slip of thigh muscle transplanted to the cheek with its own artery, vein and nerve. Two-stage (cross-face driven) for emotional smile, or single-stage (masseter driven) for a faster result.
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Temporalis lengthening myoplasty (Labbé)
The temporalis muscle is detached from the coronoid and inserted into the lip. Immediate movement, no free-flap needed — a smile with bite rather than emotion.
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Upper lid weight and lower lid tightening
Platinum or gold weight in the upper lid restores blink; tarsal strip or canthoplasty tightens the lower lid. Together they protect the cornea.
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Static sling and brow lift
Fascia lata or GORE-TEX slings suspend the corner of the mouth; a direct or endoscopic brow lift restores symmetry at rest. No movement, but no visible sag.
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Contralateral neuromodulation (Botox)
A small dose of Botox weakens the normal side to match the paralysed side at rest and in smile — a low-risk way to improve balance every 3–4 months.
Our vetted UK network
A short list of UK Facial Palsy Centres, we picked them.
Established UK centres including Queen Victoria East Grinstead, Guy’s & St Thomas’, St George’s, Salford, Southmead Bristol, Sheffield, Cambridge and Aberdeen. Introductions are made privately, once we understand your case.
Selection criteria
How we choose every centre and surgeon in our network.
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Formal UK Facial Palsy Centres (Queen Victoria East Grinstead, Guy’s & St Thomas’, St George’s, Salford, Bristol, Sheffield, Cambridge, Aberdeen)
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Consultant plastic, facial-plastic or ENT surgeons with a dedicated facial reanimation practice
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Full MDT: oculoplastics for the eye, specialist SLT and physiotherapy for rehabilitation, psychology for expectation setting
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Access to Facial Palsy UK for peer support and long-term community
Safety and recovery
What to expect afterwards — honestly.
Facial reanimation is safe in the right hands, but it is not a single operation with a single recovery. The things worth planning are timing, staging, rehabilitation and expectations.
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Timing changes the options
Under 12 months from injury — nerve procedures still work. Over 12–24 months — the muscle is denervated and a free-flap or muscle transfer is usually needed.
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Multi-stage over 2–3 years
A full plan often combines static, dynamic and eye-protection stages spread over years — not a single operation with a single recovery.
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ITU for free-flap stages
Microsurgical stages spend 24–48 hours in ITU for hourly flap monitoring. Static and eyelid procedures are day-case or one-night stays.
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Rehabilitation is the surgery’s partner
Nerve growth is 1 mm per day. Specialist SLT and physiotherapy with biofeedback is essential to relearn movement — surgery alone is not enough.
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Realistic outcomes
Around 60–80% of patients achieve a socially acceptable smile after free-flap reanimation. Complete pre-paralysis function is rare — but quality of life improves substantially even when partial.
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Flap failure is uncommon
Modern microsurgery has free-flap survival rates above 95%. Failure means a return to theatre and, sometimes, a second flap from the other leg.
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Donor site trade-offs
A sural nerve donor leaves a numb strip on the outer foot. A gracilis donor leaves minor inner-thigh weakness. Both are usually well tolerated.
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Synkinesis and revision
Unwanted co-movements can appear as nerves regrow. Botox, targeted physiotherapy and occasional revision surgery are part of the normal follow-up.
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Red flags
Sudden loss of flap colour or warmth, a corneal ulcer, or new dense weakness after surgery all need same-day contact with the specialist centre.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever combination of nerve, muscle and static procedures was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note and the next stage before your review, just ask.
- 01 Header
Cause, grade and timing
Why the palsy happened, current House-Brackmann and Sunnybrook grades, EMG/ENoG findings and how long since onset — the numbers that drive the plan.
- 02 Technique
Procedures performed and staging
Which nerve, muscle or static procedure was done, donor sites used, and how it fits into the multi-stage plan for the next 12–24 months.
- 03 Findings
Nerve viability and flap monitoring
Intra-operative nerve stimulation results, muscle viability, flap perfusion checks and any incidental findings — the technical detail your surgeon uses at review.
- 04 Impression
Rehabilitation, next stage, eye care
Read this first: SLT and physiotherapy plan, when to expect first movement, when the next stage is due, and daily eye protection until the blink is restored.
Recognised by major UK insurers
Cover for facial reanimation varies by insurer and by cause — reconstructive stages after tumour or trauma are more often funded than cosmetic-appearing revision. Many patients combine NHS specialist care with private stages. We confirm cover before booking.
Frequently asked
Everything we get asked about facial reanimation.
Honest answers on timing, outcomes, risks, rehabilitation and where in the UK this is done well.
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What is facial reanimation surgery?
A group of reconstructive plastic, microsurgical and ENT procedures that restore movement — smile, blink, eye closure and symmetry — after facial nerve paralysis. It combines nerve repairs, nerve transfers, functioning muscle transplants and static procedures, usually staged over 2–3 years.
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When should reanimation surgery be considered after Bell’s palsy?
Most Bell’s palsy recovers within six months. If there is no meaningful recovery by then, permanent weakness is likely and referral to a Facial Palsy Centre for assessment is appropriate. Reanimation options depend heavily on how long the nerve and muscle have been denervated.
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Where in the UK is facial reanimation surgery done?
It is a specialist service concentrated in a small number of centres including Queen Victoria Hospital East Grinstead, Guy’s & St Thomas’, St George’s, Salford Royal, Southmead Bristol, Sheffield, Addenbrooke’s Cambridge and Aberdeen. Facial Palsy UK maintains a patient directory.
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Will surgery give me a normal smile back?
A truly identical, spontaneous, emotional smile is rare. Roughly 60–80% of patients achieve a socially acceptable spontaneous smile after gracilis free-flap reanimation driven by a cross-face nerve graft. Masseter-driven flaps produce reliable movement but the smile is triggered by biting rather than emotion.
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How long does recovery take?
A single stage — such as an eyelid weight — recovers in a few weeks. Nerve procedures need 6–12 months for regrowth before movement is visible. A full multi-stage plan with rehabilitation typically spans 2–3 years.
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What are the main risks?
Free-flap failure (uncommon with modern microsurgery), donor-site numbness or weakness, synkinesis (unwanted co-movement), asymmetry, corneal exposure needing further eye surgery, and disappointment if expectations were not set carefully at the start.
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Do children with Möbius syndrome have the same operation?
The building blocks are similar — usually a gracilis free-flap driven by the masseter nerve because there is no working facial nerve to graft from — but paediatric centres coordinate timing with growth and schooling.
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Is rehabilitation really that important?
Yes. Specialist speech-language therapy and physiotherapy with mirror and EMG biofeedback teaches the brain to drive the transferred nerve or muscle. Surgery without rehabilitation gives a fraction of the possible result.
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What can I do about a dry, exposed eye now?
Lubricating drops during the day, an ointment overnight, taping the lid closed at night and same-week ophthalmology review. A platinum or gold upper lid weight is a small, reversible operation that restores blink and protects the cornea while longer-term plans are made.
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Does Facial Palsy UK help?
Yes — it is the national patient charity for facial palsy in all its forms. Free peer-support groups, a therapist directory and honest information written by patients and clinicians. Self-referral is welcome.
Related tests
Looking for something else?
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MRI facial nerve
High-resolution MRI to image the facial nerve pathway.
Learn more -
Bell’s palsy
Causes, recovery and when to refer for reanimation.
Learn more -
Acoustic neuroma
Vestibular schwannoma — surveillance, surgery and radiotherapy.
Learn more -
All tests
Every test and procedure we arrange.
Learn more