Facial asymmetry fix 4 years post facial paralysis? What options do I have? (Photos)

Dear Tinarina thank you for your question.

Evaluation from just to photos can be a bit difficult but by looking at your medical background and photos I understand you currently present synkinesis.

Synkinesis often occurs as a result of facial nerve injury. The term refers to the abnormal, involuntary movement of muscles that are not intended to move together. For example, smiling might involuntarily lead to eye closure. These involuntary muscle movements can be emotionally and functionally distressing for individuals affected by them.

Synkinesis can vary in severity, and its impact on an individual's quality of life can vary as well. It often requires specialized medical evaluation and, in some cases, treatments such as Botox injections, physical therapy, or surgical interventions to manage and improve muscle function and reduce the impact of synkinesis. I would advise looking for a surgeon with expertise in facial palsy or peripheral nerve reconstruction, they can fully address your situation and determine if you are a good candidate for procedures like myectomies or selective neurectomies.

It's difficult to say without the benefit of a formal evaluation. This is my expertise and a huge portion of my practice. Asymmetry is normal and expected. See an expert who does facial shaping with surgical and non surgical methods to get a comprehensive option. Best, Dr. Emer.

It appears that you have aberrant innervation after your facial paralysis. This is called the syndrome of Marin-Amat. There is a miswiring of the 5th and 7th crnial nerves. I presume when you open your mouth, the involved side closes. Targeted Botox helps but will rarely create full symmetry. This is a challenging problem.

The key to helping you is to determine the amount of levator function you have which is also understood as upper eyelid excursion. To open the left eye, you also need a working orbicularis oculi muscle (the muscle that shuts the eyelid) Like other facial muscles, the orbicularis can be weakened from the facial paralysis. Finally, a thoughtful assessment of the status of your cornea completes the picture of your resources to be helped. The right brow can be higher due to reduced motor functioning of the frontalis muscle from the facial paralysis. That can be addressed by a careful one-sided forehead lift. However, the bulk of your issue based on these photos might be accounted by the left upper eyelid ptosis. Repairing that should make a significant difference in improving your facial asymmetry. There is no substitute for a detailed in person assessment. A Zoom call its not a substitute for in person assessment. Your eyes can be your best feature.