Botox For Muscles Affected By Brain Surgery on Side of Face? (photo)

Back in 1994 I had brain surgery that affected the muscles on one side of my face. I have heard that Botox can help with the asymmetry of my face. However my concern is my nasal area and my mouth. Both of these still droop to the side. Do you think that this could help me?

Doctor Answers 5

There are many treatment options for patients with facial nerve dysfunction

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As a Charlotte area facial nerve expert, I deal with many patients with facial nerve dysfunction.  I use Botox for people that have facial nerve synkinesis.  After an injury to the facial nerve, it regenerates abnormally and the person loses the ability to move individual muscles of the face creating facial asymmetry.  I will use Botox to on both sides of the face to help create facial symmetry at both rest and during animation.


From you pictures and what you describe, I think you may have facial paralysis.  In this situation, half of your face does not move and it droops overtime.  This can cause long term functional problems including nasal obstruction, eye problems, and difficulty eating or speaking.  In this situation, there are many treatment options, but Botox is not one of them.  There are many treatment options to improve both your function and appearance.  I would seek a consultation with a facial nerve expert.  

Facial drooping following brain surgery

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Following nerve injury, from what ever cause, loss of muscle function can result in dynamic facial distortion. Depending upon the area, using Botox on the OPPOSITE side will often restore facial balance. Often there is what is known as hyperkinesia on the opposite side of the injury which is an over reaction by the brain to compensate. Botox will quiet this over compensation. Also filling agents like Restylane can be injected in the paralyzed areas to support or change the contours which are distorted.

Stephen Mandy, MD
Miami Dermatologic Surgeon
4.3 out of 5 stars 6 reviews

Botox May Be an Option For Facial Asymmetry

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It is difficult based on these photos to see exactly how your surgery has affected your facial movements. To appreciate this properly one would have to see you animated. It is hard based on these photos to know whether your asymmetry is due to injury to the brain itself or to the facial nerve which exits from the brain.

However, I can say that I have often used Botox to correct facial asymmetry. Injury to the facial nerve can , on the one hand,  leave people with weakness on the side of the injury. In this case, injecting small amounts of Botox on the opposite side may make the difference between the two sides less noticeable. However, one is limited in terms of the degree we want to weaken the strong side, as we do not want to interfere too much with function, such as smiling, speaking, sipping from a cup etc.

When a damaged nerve recovers, it sometimes grows back differently. We call this          “ aberrant regeneration”, meaning that certain branches of the nerve may cause contraction of muscles that it did not supply originally. This causes “ synergistic” contractions of muscles, such as contractions of eye muscles occurring when one smiles. In this case, Botox injected on the SAME side as the injury may help reduce these synergistic contractions and improve symmetry.

Asymmetry of movement that is a consequence of injury or damage to the brain itself, not just the facial nerve, may be more difficult to improve with Botox. Because Botox may be an option, I would recommend an assessment by a skilled Botox injection specialist.

Botox for asymmetry

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When injury or stroke causes a paralysis on one side of the face, making a smile can make the asymmetry look very significant. Some patients prefer to have Botox on the good side to make things look more equal but it may not be as symmetric as you like and could further interfere with eating and speaking. In addition, the results only last a few months.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 38 reviews

Botox for asymmetry

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Based on the photo's you've posted, I would recommend consulting with a well-trained and experienced injector. They would need to have a thorough history of your treatments and/or surgeries, as well as current information on your health. Botox if done properly, could likely help your situation.

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.