Fascia Lata Sling

If you have permanent paralysis of the muscles that support and move the face, you may be offered a procedure to try and lift the face to improve the symmetry between the two sides. The fascia lata sling procedure is an operation that can do this.

This webpage explains more about the procedure and what to expect, including the benefits, risks, any alternatives and what you can expect when you come to hospital.

If you have any further questions, please speak to the doctor or nurse looking after you.

What is it?

When surgeons treat patients with facial palsy they can perform operations that improve the symmetry of the face at rest (static procedures) or those that improve the symmetry both at rest and when moving the healthy side of the face (dynamic procedures).

A fascia lata sling operation is a static procedure as it aims to improve the symmetry of the mouth when your face is at rest. The aim of the operation is to provide you with enough mouth symmetry at rest that other people will not be able to tell you have facial palsy affecting your mouth when you are not smiling. In addition, by lifting the corner of the mouth, a sling may reduce drooling or dribbling that is a common source of social embarrassment for patients with facial palsy.

The fascia lata is a tough sheet of tissue that can be found just underneath the skin in the thigh. It is ideal for this operation as it is tough enough to support the mouth and doesn’t stretch too much with time. Beyond the scars made, you shouldn’t notice any problems with the thigh in the long term. In some situations, you may be offered tissue derived from animal skin as an alternative (‘dermal substitute’) which avoids having an extra incision on the thigh.

Who is a suitable candidate?

It may seem strange to offer an operation that only improves the symmetry of the face when you are not smiling (static procedures). However, given the complexity of dynamic procedures and the length of surgery required to perform these operations, not all patients are suitable for dynamic procedures that will improve the symmetry of their face both at rest and when smiling.

Static procedures, like the fascia lata sling, are ideal if you want a quick solution to reduce problems such as significant facial asymmetry and drooling of the mouth.

What are the risks?

In general the risks of any operation relate both to the anaesthetic and to the operation itself. The operation is performed under general anaesthetic, which means that you are asleep throughout. Your anaesthetist will go through the risks relating to the general anaesthetic with you before the operation.

Bleeding and haematoma: If bleeding occurs after the surgery, it creates a collection of blood underneath the skin called a haematoma. If this occurs, you will notice sudden swelling and bruising around the cheek and should seek urgent medical attention. This may require another operation to remove the collection of blood. This is a rare complication.

Infection: All operations are at risk of causing an infection. This can occur in around 2-5% of these operations. You should look out for increasing pain, redness and fluid discharge from the wound and fevers as a sign that you may have a wound infection. This will require antibiotics and possibly re-admission to hospital.

Scars: Wherever a cut is made, a scar will form. To begin with the scar will become red and raised, but over the coming two years it will continue to soften and flatten. On occasions, scars can remain thick and raised and in this situation the surgeon will offer you some treatments to try and reduce this. In all cases, it is important that you massage the scar a couple of times a day once the wound has healed to help soften the scar. This should be continued for 2 years.

Asymmetry: The side of the face that has been operated on will never be perfectly symmetrical with the other side. It is also important to remember that you still won’t have movement on the side of the face that has been operated upon and that the asymmetry will be worse when you smile. Furthermore, this operation only aims to address the asymmetry of the mouth and won’t change the symmetry of the eyes or forehead.

Because the fascia lata sling will slowly stretch with time, your surgeon will probably over-tighten the sling initially to allow for this. After many years it may be necessary to re-tighten the sling to restore the desired position.

Numbness: Cheek numbness is a common side effect of most facial surgery and generally improves over a period of weeks to months.

Sling dehiscence: This means that the sling pulls off from the areas that it has been attached to. This can be either the lips or the cheek bone. The surgeon will take extra care to try and minimise the risk of this happening, but if it does occur you may require another operation to correct the position of the fascia lata sling. In every sling procedure, there is a gradual weakening of the sling over time, which results in a slight loss of position. The sling is often overtightened initially to account for this.

Are there any alternatives?

This is not a life-saving procedure and, therefore, the main alternative is to have no surgery at all. If you have decided that you would like surgery to improve your appearance and the function of your face, other alternatives do exist. Broadly speaking these can split into those that improve the symmetry of your face at rest but do not produce any movement (static procedures) and those that improve the position at rest and can produce movement of the face to express emotions (dynamic procedures). The fascia lata sling procedure is a static procedure. The main advantages of static procedures are the shorter length of surgery and hospital stay, the ability to perform the surgery in one operation and the reduced risk of failure. Dynamic procedures are longer, more complex and come with more risks. Many options exist in both categories and your surgeon can discuss these with you.

How can I prepare for a fascia lata sling operation?

You will need to take time off work for the surgery. To begin with, you will be in hospital overnight. After this, we would recommend that you take a further two weeks off work to recover. If your job involves heavy exertion, you should take a total of one month off work.

Any sports should be avoided for 4-6 weeks and you should try to stop or cut down any smoking in the lead up to the operation and for the six weeks following surgery. Smoking will increase the risk of the muscle not working and the wound not healing.

With this being an operation performed under general anaesthetic, you will need to avoid any food in the six hours before surgery. You may drink water up until two hours before surgery.

Prior to coming in for surgery you will most likely be seen in a pre-assessment clinic. In this clinic they will go through any other medical problems that you have and list any medications that you take. Advice will be given on which medications to stop before surgery.

What does the surgery involve?

This operation is done under general anaesthetic so you will be asleep throughout the procedure. The operation lasts around three hours.

The fascia lata is just underneath the skin of the thigh. A section can be removed between two separate cuts made in the thigh.

The surgeon will then make a cut in front of the ear and make a pocket underneath the skin of the cheek through which the fascia lata sling can be passed. In addition to this cut, further cuts are made on either the outside or inside of the upper and lower lips so that the surgeon can ensure that the fascia lata sling is stitched into the correct position to give you the best possible outcome.

The surgeon will then stitch the fascia lata into the correct positions around the mouth and will then carefully adjust the tension to give your mouth the best possible symmetry. The outer end of the fascia lata sling is then stitched to your cheek bone to anchor the sling in place and reduce the likelihood of it moving.

Finally, the cuts are stitched up and a drain may be placed for the first day or two to reduce swelling.

Will I feel any pain or discomfort?

After the surgery it is likely that you will feel some pain, although you will be given a number of different painkillers to reduce and ideally remove this pain. The pain is normally around the wounds themselves and should begin to subside in the first 72 hours after surgery. You will be discharged from hospital with some tablet painkillers, which should control the pain. If you find that the pain is uncontrollable, or getting worse, you should contact your surgical team or the ward you were discharged from.

What happens after the surgery?

In most cases you will be able to go home the day after your operation and you should aim to take things easy at home for at least two weeks. It is advisable to have a soft diet for the first ten days to avoid pulling the sling out of position (dehiscence).

You should expect your face to become swollen after the operation and this will take a couple of weeks to subside. To begin with, you may find it difficult to eat and drink normally, similar to how it would feel after a trip to the dentist. Sleeping propped up on a few extra pillows at night will help to reduce this swelling quicker.

Will I have a follow-up appointment?

Your surgeon will make arrangements to see you around one week after leaving hospital to check that all is well with the wounds. They will also arrange an appointment to see you in their outpatient clinic to check on the final result.

What should I do if I have any concerns?

If, following the surgery, you have any concerns you should contact your surgical team or the ward that you were admitted to during your stay. They will then be able to give you further advice on what to do and whether they need to see you back at the hospital or not.