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Botox Risky if You Have Bell's Palsy History?

have a slightly drooping lid and smile/bell's palsy incomplete smile & sliglhtly smaller eye, droopy lid- both residual from bell's palsy. b/c i got from bell's, nerve problem, i'm alittle afraid of injecting something which also might affect the nerves. botox was suggested, but again, would it be risky b/c of bell's history? i once tried restylane below for tired lines and when it plumped up bottom, made smaller eye look even smaller. any experience with this? trying to avoid potential problems before doing anything. want old smile back but can live with this, but eye issue really bothers me. opinions and suggestions greatly appreicated. thanks...

Doctor Answers (7)

Check with your neurologist first

+1

It would be safest for you to check with a neurologist who can examine you and determine if the Botox is safe. Despite your history of Bell’s Palsy, it might be fine for you. Fillers in the tear trough usually don’t create so much volume that the eyelid raises up, but with your droop this would make sense. Maybe a little less filler can be used next time.


Manhattan Dermatologist
5.0 out of 5 stars 31 reviews

Botox and Bell's Palsy

+1

If you have an old Bell's Palsy that has not improved, Botox is a great way to balance the effects of the Bell's Palsy. You may also consider surgical intervention of the affected side.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 15 reviews

Botox for facial weakness

+1

Botox has a long history of being used in patients like yourself. It is typically injected at a higher dose into the non affected side to produce better symmetry. Botox is one option that is very safe and can be done in the office. It will not produce further damage to your weakened nerves.

Other surgical options exist, most are not office based. Often a unilateral eyebrow lift will help with the droopy eyebrow and lid on the affected side. I believe that is most likely the cause of your "smaller" eye. A meloplication or thread based midface lift can help with mouth and nasolabial fold asymmetry. Again, this is a bit more invasive and typically involves some form of anesthesia. I would not have recommended a filler for the problem you describe. You should be happy that it was not a permanent intervention. Same thing is true for botox if you decide to move forward with this treatment but do not like it.

Good luck

Richard W. Westreich, MD
Manhattan Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

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Is botox safe for patients who have had Bell's Palsey

+1

Botox is a superb way to "normalize" a face that shows asymmetry as a consequence of Bell's Palsey. Very often, the unaffected side shows hyperactive expression in an attempt to compensate for the opposite side's paralysis, and this can be relaxed into a more normal repose. However, use of Botox to achieve this effect should be done by someone with superb knowledge of facial muscle function and great experience with the finesse of Botox injection. Fillers also can be helpful in dealing with the atrophy that often accompanies long periods of disuse of some of the facial muscles.

Stephen Mandy, MD
Miami Dermatologist

Botox on Bell's Palsy patient can be done, but care is required

+1

Dear Dancer

BOTOX is occasionally used to help balance the facial asymmetries associated with the Bell's palsy. A great deal of care is warranted when treating the side with the Bell's especially when there is a little motor nerve function, as this can be further compromised. I would recommend that if you are interested in pursuing this treatment option, you see a fellowship trained oculoplastic surgeon. The American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) maintains a website with a member directory at www.ASOPRS.org Here you can find oculoplastic surgeons in your area. I recommend having a consultation and seeing where this takes you.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
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Botox can be effective treatment for patients with residual bells palsy

+1

Botox can be effective treatment for patients with residual bells palsy. Botox has a mechanism of action that blocks the release of a chemical that causes muscle contraction. Bell's palsy on the other hand affects the nerve itself and is thought by many to be the result of a viral infection although that too has not been proven.

If you are left with some residual drooping from a Bell's palsy, often times botox injections can help by minimizing twitching of muscles that can occur. Also, judicious use of botox in the right locations can minimize depressor or downward pulling muscles and let the elevators or raising muscles win out. It is much like a see saw. If one side is too heavy, it will pull down the person to that side. With botox if you weaken a muscle that is part of the downard pulling process, even if the elevator is weak from a bell's palsy, it has less oposition to the downard motion.

However, I would suggest going to someone who is well trained in botox injections so that they can affect the result you might be looking for.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
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Botox for Bell's palsy

+1

Botox is commonly used to treat the OPPOSITE side effected by Bell's palsy and therefore it should not effect the nerve on the diseased side.

I don't quite understand your eye comment. Typically the Bell's palsy side is more open or wide due to the nerve damage. Your comments make it sound as if that is the smaller side. Is that true?

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 41 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.