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 10

Botox for Bell's Palsy

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These are great questions! Botox and fillers can both be effective ways to treat the residual symptoms from Bell’s palsy, but require the experience of a facial nerve expert to administer them. There are lots of physicians who do these types of injections, but very few worldwide who use them to specifically treat facial nerve damage. Botox is a safe treatment and can help with both cosmetic and functional concerns that many Bell’s palsy patients have. Often times, patients are left with residual Bell's Palsy symptoms called synkinesis, which results in an extreme tightening and mis-coordination of certain facial muscles. Botox is a very effective treatment for this but to be used strategically and injected in just the right places to provide patients with the relief that they are looking for. I urge you to find a physician who specializes in treating patients with facial paralysis for these injections, instead of someone who uses them for strictly cosmetic purposes. There are vew few physicians around the world who help patients with facial paralysis, so I see patients both in person and via Skype for consultations. During an initial consultation, I would be able to assess you and determine if Botox is the most beneficial treatment for you. I work together with my patients to provide them with a treatment plan that is customized around their medical history and their ideal outcome. If you are interested in speaking in more detail about your specific concerns, feel free to contact me to set up an appointment. Good luck!

Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Botox after Bell's palsy

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When patient's have acute or early Bell's palsy, treatment of the Bell's should be first priority. If a full recovery is not made, Botox can be helpful to improve the symmetry of the face.  There are not any known instances of Botox triggering a Bell's palsy and it is frequently used to improve symmetry in the face.  Facial paralysis results in one portion of the face not moving or only partially moving.  When the face animates the non affected side’s movements are often pronounced and can sometimes create abnormal movements called synkinesis.  By placing botox in the overly active side (i.e. the NON-Paralyzed side), the facial movements can look more symmetric in appearance.  This is most easily performed in the upper face and the lower face requires expertise in facial anatomy and facial paresis.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 181 reviews

Botox to treat synkinesis

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First of all I'm sorry that you have to deal with this issue, but it is a very common complication from poorly recovered Bell's Palsy.  Your eye is tight and more narrow as a result of the hypertonicity in that muscle and it is very effectively and commonly treated with botox. Botox is very safe for you and there is absolutely no reason to worry about it, even though you have had Bell's palsy. It is very important however that you see a physician who specializes in the treatment of facial paralysis.  There truly are very few across the country that see a high volume of facial paralysis patients on a regular basis.  There are other potential treatment options for you including specialized facial therapy as well as occasional surgical options.  Seek out and find a facial paralysis expert in your area, or feel free to come to Iowa to see me.  Happy to discuss over the phone or via Skype.

Douglas K. Henstrom, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 17 reviews

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Check with your neurologist first

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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.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
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Botox and Bell's Palsy

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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
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Botox for facial weakness

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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
4.9 out of 5 stars 55 reviews

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

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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 Dermatologic Surgeon

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

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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 Here you can find oculoplastic surgeons in your area. I recommend having a consultation and seeing where this takes you.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Botox can be effective treatment for patients with residual bells palsy

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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
5.0 out of 5 stars 20 reviews

Botox for Bell's palsy

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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
4.9 out of 5 stars 86 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.