Rapid Restoration: Suture Stabilization of the Central Facial Landmarks

Background: Reinnervation procedures for patients with flaccid facial paralysis (FFP) often require a lengthy delay until facial symmetry is restored. We have incorporated a simultaneous suture-based “rapid restoration” (RR) to symmetrize the mid- and lower face in the early postoperative period. Methods: We studied patients with FFP who underwent facial reanimation from March 2022 to February 2025 where dynamic changes were not expected for at least 4 months. We used Emotrics to measure nasolabial fold (NLF) angle, upper lip slope, and oral commissure (OC) height and calculated symmetry indices. Results: We included 13 patients who underwent RR and 15 patients who underwent only dynamic reanimation. Patients who underwent RR experienced the following median changes: resting NLF angle increase from 7.1° to 26.0° with improvement in symmetry index from 22.7% to 88.9% ( p < 0.001); upper lip slope decrease from 26.2° to 21.2° with improvement in symmetry index from 42.7% to 76.0% ( p = 0.025); and OC height asymmetry decrease from 5.7 to 1.8 mm ( p < 0.001). Patients who did not undergo simultaneous RR realized no significant changes in NLF angle, upper lip slope, or OC height. Conclusions: RR performed alongside dynamic facial reanimation procedures helps to eliminate major asymmetry associated with FFP while awaiting restoration of facial function.