Overview
Congenital facial paralysis is weakness of the facial muscles that is present at or shortly after birth. It can affect one or both sides of the face and may involve the whole face or only certain areas, such as the lower lip or the eyelid.
The cause may relate to how the facial nerve or muscles developed, to a syndrome that affects several nerves, such as Moebius syndrome, or to pressure or injury around the time of delivery. Some forms improve on their own, while others are lasting.
Evaluation focuses on protecting the eye, supporting feeding and speech development, and determining the cause and pattern of weakness. For lasting paralysis, smile reanimation and other reconstructive options may be considered as a child grows, with care coordinated across specialists.
Symptoms
Parents may notice that an infant's face does not move evenly, that one eye does not close fully, or that the smile is uneven or absent. Feeding difficulties and drooling can also occur.
In some forms, weakness is most apparent during crying or smiling, when the difference between the two sides of the face becomes clearer.
Living with congenital facial paralysis? The next step is a quiet, unhurried conversation.
Causes and risk factors
Congenital facial weakness can result from how the facial nerve or muscles developed before birth, from syndromes that affect several cranial nerves such as Moebius syndrome, or from pressure or injury around the time of delivery.
Developmental causes are often permanent, while some birth-related forms improve over the early weeks of life.
How it is diagnosed
Diagnosis begins with a careful history and examination of facial movement, eye closure, and feeding. The pattern of weakness helps distinguish developmental causes from injury-related forms.
Hearing tests, imaging, genetic evaluation, and assessment of other cranial nerves may be recommended, often with input from pediatrics, neurology, and ophthalmology.
Treatment options
Care is staged and coordinated across specialists:
- Eye protection and lubrication to safeguard the cornea
- Feeding and speech support in infancy and childhood
- Facial physical therapy and neuromuscular retraining
- Cross-face nerve grafting for selected candidates
- Gracilis free tissue transfer for smile reanimation
- Static procedures to improve symmetry and support
Timing of reconstructive options depends on the cause, the pattern of weakness, and the child's growth and development.
When to seek care
Facial weakness noticed in a newborn or infant should be evaluated, both to protect the eye and to identify the cause. Early assessment also helps support feeding and development.
Seek prompt care if the eye cannot close and is becoming red or irritated, or if feeding is significantly affected.
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who treat congenital facial paralysis
Dr. Rakhna Araslanova
MD, FRCSC, FACS
Fellowship-Trained Facial Plastic & Reconstructive Surgeon — Facial Paralysis and Reanimation
Dr. Rakhna Araslanova is a fellowship-trained facial plastic and reconstructive surgeon who leads facial paralysis and reanimation at Norelle Health, with additional expertise in craniofacial reconstruction and aesthetic facial plastic surgery.
- Facial paralysis rehabilitation and surgical reanimation
- Craniofacial reconstruction
- Aesthetic facial plastic surgery
- Rhinoplasty
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
It can result from how the facial nerve or muscles developed before birth, from syndromes that affect several cranial nerves such as Moebius syndrome, or from pressure or injury around delivery. Evaluation helps identify which cause is present.
Some birth-related forms improve over the early weeks of life, while developmental forms are often permanent. The outlook depends on the cause and pattern, which is why evaluation is important.
When the eyelid cannot close fully, the surface of the eye can dry out and become injured. Lubrication and other protective measures help keep the eye safe while the longer-term plan is developed.
For lasting paralysis, smile reanimation options such as cross-face nerve grafting and gracilis free tissue transfer may be considered as a child grows. Whether and when these are appropriate is individualized.
Evaluation may include hearing tests, imaging, genetic assessment, and examination of other cranial nerves, often coordinated with pediatrics, neurology, and ophthalmology.
No. Bell's palsy is a sudden, usually temporary weakness that develops later in life, while congenital facial paralysis is present from birth and has different causes and management.
Care is often shared among facial plastic and reconstructive surgery, pediatrics, neurology, ophthalmology, and speech and physical therapy, depending on the child's needs.
Eye protection and feeding support begin early, while the timing of reconstructive procedures depends on the cause, the pattern of weakness, and the child's growth and development.
Related Procedures
1 of 3 · Cross-Face Nerve Graft
Related Conditions
Request a consultation for congenital facial paralysis
Schedule an evaluation with our team to review your symptoms and the appropriate next steps.