I have a face damaged from a 15 year old bells palsy /ramsey's hunt could have been either. I have been all over to get opinions but resist any permanent work as my face has multiple issues. I have had luck with Botox in the eye and fr spasms but how do you find someone who is well trained enough in this area to really provide some solutions. Plastics, Ent nueromas??
Damage from Facial Paralysis- How to Find Best Botox Providers For This Issue?
Doctor Answers (8)
Seek a facial plastic surgeon with experience in facial paralysis treatments
Botox is one of the most effective treatments for patients with Bell's palsy, partial facial paralysis and synkinesis. You should find a doctor who is an expert in facial paralysis. Without expertise in facial paralysis/Bell's palsy it will be difficult for a doctor to know exactly where to inject the Botox to give you the best results. Before you let someone perform Botox treatments on you, ask how much experience they have using Botox for facial paralysis. Overall, a facial plastic surgeon is the best board specialty (as opposed to ENT, dermatologist or general plastic surgeon) to perform the Botox injections.
Web reference: http://www.facialparalysisinstitute.com/19/Botox.html
Injectables for synkinesis
One thing that was not mentioned below is that injectable fillers can often be used together with botox to further improve facial symmetry. Synkinesis often creates a deeper smile line (nasolabial fold) on the affected side, and a fuller cheek, and fillers can be used to even out these characteristics to achieve as much facial symmetry as possible. Take care and best of luck.
Try the ASPS website to find qualified board certified plastic surgeons in your area. From this list, you will be able to consult 2 - 3 who regularly perform this procedure.
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Facial paralysis requires a subspecialized plastic surgeon
Facial paralysis requires someone with a large experience in treating patients exhibiting varied presentations and etiologies. Although some aspects of facial paralysis such as synkinesis and asymmetry can be effectively treated with non-surgical solutions such as Botox or Dysport, it is the plastic surgeon with microsurgical skills and extensive experience with tissue transfer that can deliver the full spectrum of services to properly reconstruct the paralyzed face. There is a huge difference between surgeons (facial plastic or otherwise) claiming to treat patients with the older STATIC methods of reconstruction vs the desired DYNAMIC reconstructions. Also, some of the stubborn residual damage of Bell's palsy may require more aggressive interventions beyond precise Botox injections. Make sure you seek a plastic surgeon with such experience and training. You can find more information on my website.
Botox can help create better symmetry with neurologic disorders
There can be considerable asymmetry of muscle activity and facial appearance with neruologic disorders. There is no specific specialty hybrid that encompasses neurology, plastic surgery and ENT and dermatology. Dr. Andrew Blitzer in NYC does a fair amount of treatment for TMJ and other facial muscle disorders. It is possible for a local Botox expert to work with your neurologist and determine which muscles can be treated with botox to create the results your desiring.
Web reference: http://www.thenyac.com/botox/index.html
Botox & other rehab options after facial paralysis
I would seek an experienced Botox injector in the area and then ask them if they have experience in the realm of facial paralysis rehabilitation. Your best bet is a facial plastic or plastic surgeon, with an ENT being your next best option.
There are a variety of options available for rehab after facial nerve paralysis which range from simple to rather complex. You alluded that you do have some more "complex issues," but I would suggest that since the paralysis has been present for 15 years, it is reasonable to consider some "permanent" procedures to reduce the stigmata of facial paralysis and improve your appearance. Your best recommendations depend on your individual face and how much movement you have (if any).
Botox for Facial Paralysis
Sometimes it is difficult to find someone who has a lot of experience with Botox in the setting of facial paralysis. You could search Real Self or the Web for "synkinesis."
Many oculoplastic surgeons will be very experienced in using Botox to help such patients. ASOPRS.org will list surgeons in your area.
Some surgeons work closely with allied health specialists who help patients with Neuromuscular Retraining. One of the experts in this discipline is Jackie Diels. The attached link is to an article she posted on the Bell's Palsy web site. Hope this helps!
Mark Lucarelli, MD, FACS
Web reference: http://www.bellspalsy.ws/printretrain.htm
Best to Call Around
BOTOX is useful for facial paralysis as it can rebalance the face. Usually plastic surgeons or ENT specialists do facial reanimation surgery and have experience with Botox in these cases. Opthalmologists would have experience for facial paralysis around the eye and forehead. Botox is very useful in rebalancing the forehead, eyes, and the lips. You should ask the doctors office to see if they have much experience in treating facial paralysis with BOTOX.
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.
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