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Facial Paralysis and Reanimation

Providing expert, personalized care for patients who have permanent weakness or paralysis of the muscles that are used in facial expression.

In 2002, the Duke Facial Paralysis Program was initiated by Dr. Jeffrey R. Marcus and Dr. Michael Zenn, of the Division of Plastic Surgery at Duke University. Dr. Marcus, trained in Pediatric Plastic Surgery and Craniofacial Surgery at the Hospital for Sick Children in Toronto Ontario, brought the teaching and organization of the renowned Toronto “Smile Surgery” program to North Carolina. Dr. Zenn, a nationally recognized Duke plastic surgeon with extensive experience in microsurgery also spent time at the Toronto program learning the technical aspects of this challenging field. Together, they began seeing patients with facial paralysis of all ages to help restore (or create anew) the ability to smile. They quickly recognized the importance of proper rehabilitation and therapy to delivering the best results, and enlisted the help of Lisa Massa, a specialist in physical therapy with experience helping patients affected by Bell’s Palsy and other forms of facial paralysis.

Today, the Duke Facial Paralysis program sees patients from throughout the State of North Carolina, from regional and distant states, from other countries. The program has been designed to accommodate the needs of patients traveling from near and far. Not all patients have the same needs, and not all patients are candidates for the same procedures. “Smile Surgery” refers to a particular type of facial reanimation which is best suited to patients with total or near-total loss of the ability to smile. 

"Smile Surgery"

Surgeons have attempted to help patients with facial paralysis for more than 50 years.  Over this time many techniques have been developed, some which are still in routine use today.  The most important advances, however, have been made in the last 10-15 years, with continuing improvement still ongoing.  “Smile Surgery” is a form of surgery that aims to improve one particular aspect of facial paralysis – the ability to smile.  It does not address problems with eye closure or the ability to move the eyebrows.  For these movements, there are other procedures with long track records for benefit. 


“Smile Surgery” most often consists of two separate surgical procedures, generally separated by a period of 6-12 months. To understand how these procedures help, it is useful to consider first the patient with one-sided facial paralysis. In this situation, the facial nerve on one side does not function.  For those born with the condition, the muscles of expression do not develop. The facial nerve conducts electrical currents from the brain. The nerve is attached to a muscle, which performs the action. If we think of the situation simplistically, there are then two problems – a lack of electrical “wiring,” and a lack of a muscle that is able to perform. For patients who at one time had a working facial nerve, but who have lost it, the situation is similar. In this situation, the muscles were once present. However, if enough time has elapsed, the muscles lose their ability to respond even if they are provided with a stimulus. In either case, we need to restore two things: the nerve supply and the muscle to act. These are the two stages in “smile surgery”.

Physicians and Staff


Name Areas of Special Interest
Jeffrey R. Marcus, MD Craniofacial surgery for children and adults including cleft lip/palate and craniosynostosis; rhinoplasty for cosmetic and/or breathing issues; microsurgical facial reanimation for facial paralysis; microsurgical repair of brachial plexus injuries in infants; broad scope of pediatric plastic surgery including skin conditions, congenital hand surgery, ear reconstruction; assistance to families of internationally adopted children with cleft lip and palate



Lisa Massa, PT, WCS, CLT                                          
Physical therapist
Darcy Little, PT Physical therapist
Brittany Pfederer, PT Physical therapist
Katie Walker, PT Physical therapist

Clinic Hours and Locations

Clinic hours and locations vary by physician. Please contact your doctor's office to clarify the location of your appointment if there is any question.

Duke Children's Hospital & Health Center
2301 Erwin Road
Durham, NC 27710
Tel: 919-668-4000

Duke Aesthetic Center
3475 Erwin Road
Durham, NC 27710
Tel: 919-681-8555

Duke Clinic 3J
200 Trent Drive
Durham, NC 27710
Tel: 684-6456 

Appointments and Contact Information

Susan E. Anderson, RN
Division of Plastic Surgery
Cleft Palate/Craniofacial Team Coordinator
DUMC Box 3974
Durham, North Carolina 27710
Phone: 919-684-6740
Fax: 919-681-2670