Botox for Bell's Palsy Twitching?

I have Bell's Palsy. It has been over a year now, and although my face looks fairly normal, I now have a twitching in my eye, especially when I eat and drink. This is due to cross wiring of the nerve. I would like to know, would Botox be helpful for me, and if so, where exactly would it be injected?

Doctor Answers 8

Botox and Bell's Palsy

Thanks for your question.

Bell's Palsy (both symptomatic spasm and for symmetry) is a medical indication for Botox.

Many insurance plans will cover treatment so call your insurer to check if your covered.

I hope this helps.

San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Botox for Synkinesis

Great question! Yes, it sounds to me like you are experiencing synkinesis which is, as you described, a mis-coordination or cross-wiring of the facial nerve. Synkinesis can cause tightening of certain muscles and may be contributing to the twitching that you are experiencing. I would recommend consulting with a facial nerve specialist like myself who will be able to assess you in person to find out exactly what form of treatment would be most beneficial for you. Botox can dramatically improve the symptoms of synkinesis by strategically limiting the activity of certain muscles even on the unaffected side of the face, which helps with overall facial coordination. I specialize in treatments for facial paralysis and see patients like you from all over the world who want to improve their synkinesis. There are very few physicians who specialize in using Botox for synkinesis, so it’s extremely important that you see an expert who has years of experience treating patients with facial paralysis. I would be happy to discuss your case in more detail or see you for a consultation. Feel free to contact or call (310) 657-2203 for more information.

Babak Azizzadeh, MD
Beverly Hills Facial Plastic Surgeon
4.1 out of 5 stars 9 reviews

Neuromuscular Retraining and Botox are a great combination for facial synkinesis

HI.  I see that your question was posted quite some time ago.

Many patients who acquire facial paralysis (from Bell's palsy, trauma, or other reasons) develop abnormal movements of facial muscles about 6 months after the paralysis occurs. As mentioned, this is called facial synkinesis.

Some occupational therapists can be very helpful with a treatment called Neuromuscular Retraining. In the U.S. one of the very best is a woman named Jackie Diels, OT. Perhaps there is someone with like Jackie in your area.

Botox works wonderfully for synkinesis.  The key is small doses and strategic placement (avoiding muscles which would be problematic if effected by the Botox). An ophthalmologist or an oculoplastic surgeon may be particularly valuable in your care.

Hope this helps.

Mark Lucarelli, MD

Madison, WI

Mark J. Lucarelli, MD
Madison Oculoplastic Surgeon
5.0 out of 5 stars 13 reviews

Give it time

I agree with Dr.Placik that this is a "form" of facial synkinesis. Depending on how long and how severe your Bell's Palsy was will depend on the eye issues that you're having.

Before you look into Botox I would consider either waiting or maybe a week of Medrol. When nerves get injured due to a virus and result in Bell's Palsy they can take years to heal.

So give it time first before you jump into something that could be very damaging in the wrong hands.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

Botox for eyelid spasm/twitching

I would consult an ophthalmologist or other practitioner with experience treating blepharospasm with Botox. The technique involves injecting small doses of botox to several locations above and below the eyes. Frequently insurance will reimburse for this indication, and you and/or your treating office can check with your insurance company regarding coverage.

Good luck.

Bryan K. Chen, MD
San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Synkinesis following Bell's Palsy

You are describing a common phenomenon called: FACIAL SYNKINESIS, which may occur after facial trauma or Bell's palsy. Neuromuscular therapy and Botox are the mainstay of treatment. Rarely, advanced or resistant cases may require surgery.

You may want to look this up online and seek care from an individual with experience in this area. In terms of the areas to inject, it really depends on which nerves/muscles are affected. There are some muscles( i.e., orbicularis oculi) you can inject and others that may exhibit spasms but you would not want to inject (i.e., zygomaticus major).

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 82 reviews

Yes, speak to your ophthalmologist.

Yes, this is one of the primary indications for medically-necessary Botox use. You should speak with your ophthalmologist, who has experience in this area, to arrange for the injections. Good luck.

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 77 reviews


It sounds like you have a blepharopsm which is one of the medical indications for Botox(r). Injection should be along the orbitcular muscle with care not to inject too close to the lower eyelid. This should help your problem tremendously and in some cases will be reimbursed by insurance.

D.J. Verret, MD
Dallas Facial Plastic Surgeon
3.9 out of 5 stars 14 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.