Manuel A. Lopez, MD, FACS

Board Certified Facial Plastic Surgeon

(210) 495-5771 (LPS1)
(210) 495-2367          
Lopez Plastic Surgery
1314 E. Sonterra Blvd, Suite 5104
San Antonio, Texas 78258

Facial Reanimation

One of the most socially and functionally disruptive maladies is a facial paralysis. Facial paralysis usually results from trauma, surgery, or a Bell’s palsy. Problems that result from a facial paralysis include exposure of the eye which can lead to chronic irritation, a disfiguring appearance, and drooling.

The duration that the facial paralysis has been present will help Dr. Lopez determine which procedures the patient would benefit from. Dr. Lopez comprehensively treats patients with facial paralysis by addressing the eye, cheek and area around the mouth.

Patients that have a facial paralysis are unable to completely close their eye and therefore leave the cornea exposed to the elements which can cause irritation, infection and even blindness. Dr. Lopez performs procedures that include a gold weight to the upper eyelid and a lower eyelid elevation which narrows the fissure of the eye and protects the eye from exposure.

With time, a patient with a facial paralysis will experience sagging of the face. To correct this, Dr. Lopez performs a browlift and midfacelift which provides a more natural youthful appearance.

One of the most distressing results from a facial paralysis is the drooping of the corner of the mouth which can lead to drooling as well as a disfigured appearance. Dr. Lopez performs a minimally invasive temporalis tendon transfer (T3) to correct the asymmetry of the mouth as well as give motor function to allow for smiling.

For patients that have had a facial paralysis for less than 18 months, a nerve procedure can restore tone and some muscle movement to the lower third of the face. Dr. Lopez connects part of the nerve that innervates the tongue to the facial nerve that no longer works. This will give tone to the lower muscles of the face to prevent drooping and possibly restore some motor function.

When discussing reanimation procedures the best place to start is by looking at before and after photos to see just what can be accomplished. Often times many procedures are combined to achieve a complete facial reanimation. The most common combination includes a gold weight for the upper eyelid blepharoplasty, a lower eyelid elevation, a browlift, a midfacelift, and a minimally invasive T3.

At your initial consultation, Dr. Lopez will evaluate the bony and soft tissue architecture of your face. An overall assessment of the face provides the basis for what one may expect from facial reanimation. Age, along with the degree of deformity and function are important factors influencing the outcome of an operation.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and preoperative and postoperative routines is essential to a successful final result.


At your preoperative appointment Dr. Lopez will go over the instructions with you to follow before and after surgery. Preoperative photographs will be taken and your questions will be answered. A complete facial reanimation can take about 4-5 hours depending on the underlying structure. Recovery time from the anesthetic takes about an hour and most patients are admitted to the hospital for overnight observation.


  1. Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for two weeks prior to and two weeks following your surgery. See our “Medication List” for products to avoid prior to surgery. If you are on any medications that affect bleeding (such as coumadin or warfarin) please notify the office immediately.
  2. Please refrain from tobacco products for six weeks and alcohol for one week prior and three weeks following surgery. Along with delayed wound healing, persistent skin redness and other complications may persist when tobacco and alcohol are not discontinued.
  3. Please notify us of all routine medications and significant health history. We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment you will be told which daily medications to take with just a sip of water on the morning of surgery.
  4. At your preoperative appointment you will be given prescriptions for use following surgery including an oral antibiotic, antiswelling medication, antibiotic ointment and pain medications. Please obtain these prescription medications before your surgery so you will have them ready for use when you return home after surgery.
  5. We will ask you to take Arnica, a natural herb that significantly decreases bruising, before and after surgery. We will also ask you to take Vitamin C (ascorbic acid), which helps promote healing, before and after surgery.
  6. You may not eat or drink after midnight the evening before the procedure unless instructed otherwise. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
  7. Remove all make-up and nail polish before arriving for your procedure.
  8. Someone will need to drive you home after your surgery and stay with you that evening. Transportation to the office for dressing removal the day following surgery is also required.


When you wake up from surgery you will notice a soft, bulky head wrap dressing. You will be asked to come to Dr. Lopez’s office the following day after surgery for dressing removal. You will be asked to return in five to seven days for suture/clip removal.


Wound care

  • Keep dressing dry and intact the evening after surgery.
  • Following dressing removal the day after surgery, you will notice little clips in your hair. We will again instruct you on wound care. Cleaning the suture with a Q-tip dipped in hydrogen peroxide and then applying the antibiotic ointment three times a day is an essential part of the healing process.
  • You will be asked to return to the office about seven days after surgery for removal of clips and/or sutures. Because most patients tell us their forehead is temporarily numb following a browlift, it is uncommon for patients to complain of significant pain with clip/suture removal.


Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Vicodin and Percocet contain Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin or Percocet. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.

  • Start your antibiotic (Keflex) when you get home and one at bedtime. It is not uncommon to have a low-grade fever for 24 hours following surgery.
  • Vitamin C helps promote healing. Take 1000 mg three times a day for one week following surgery.
  • Arnica, a natural herb that significantly decreases bruising, is used under the tongue three tabs three times a day before meals for two weeks.


Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions. Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.


Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Two weeks off work is recommended.

After 48 hours, you are allowed to shower and gently wash your hair. Make sure that the hair is dried thoroughly, but do not use a hair dryer for the first two weeks. Sensation to the scalp will be diminished temporarily so you want to avoid causing a burn because of a hair dryer.

Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following facial reanimation surgery to prevent pigmentation of incision lines.

Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Since vision is temporarily compromised, assistance with daily activities is recommended.

Final Result

Following a facial reanimation procedure, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following surgery, however three weeks is ideal, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following a facial reanimation are not apparent for one full year following surgery. Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to ensure that you’re healing as anticipated.

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