Diagnosis and treatment options can be given for one side of my lower face drooping or looking slightly paralyzed.(photo)

I've seen a neurologist and had an MRI which came back totally normal. She said I Don't have Bell's palsy or any tumors. I do not have any issues with drooping eye or eyebrow, it's strictly lower o what gives?! What's next? Would facial exercises help? Facial stimulation, acupuncture, Botox? I don't want to look totally different maybe just a little bit more symmetrical.

Doctor Answers 7

Diagnosis and treatment options can be given for one side of my lower face drooping or looking slightly paralyzed.

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Hi Lainey,     I would actually Botox you in your left upper naso-labial fold to drop your smile a bit on the one side. Additionally, I would do a little micro- Botox along your upper cheek line to further help even out your smile. We are all a bit asymmetric and would probably do some filler (Juvederm) on your right upper lip. I do suggest that you see another neurologist for a second opinion and do not believe that any facial exercises would benefit you at all.  Good luck,Dr. Downie

Montclair Dermatologic Surgeon

Facial paresis treatment

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I see a facial paresis on the right. I would seek out another opinion. If this is Bell's Palsy, the nerve usually comes back to normal. Did this happen after a Botox treatment? I wouldn't do any treatment at this point until I have a better handle on what the cause is. Usually for this problem, steroids and Valtrex are prescribed. An ENT consult is also advisable.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.8 out of 5 stars 52 reviews

Facial Droop

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First, I would also see an Otolaryngologist to make sure there is nothing else going on in your parotid gland and just for a second opinion. Steroids could be helpful and should be started as soon as possible, so I would see someone on the sooner side. 

If this is truly a case of facial paralysis without a clear cause, there are some options to symmetrize your face. Its difficult to say which approach (botox/surgery) without an examination in person. Good luck!

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Facial paralysis treatment options

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We see and take care of many patients every week with facial nerve disorders at Hopkins. Sometimes, there is no clear cause of a partial weakness. The strategies we use are very individualized. Often, the judicious use of Botox or Dysport, and sometimes with some filler, can achieve greater symmetry. Cases like yours (as far as I can tell from the single image) often dont need much more than this. Thankfully, we know that no ones face is perfectly symmetric. So, even when we can only coax out of the case a little bit more symmetry, the resulting improvement can be quite meaningful. 

Uneven Smile

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From your photo it looks like on the left you have what we call a 'gummy smile'. 2 or 3 units of botulinum toxin, placed in tha nasal alar region, will relax the left side and likely lead to a more even looking smile. You will meed to repeat this every few months.


Lisa Vuich, MD

Facial droop

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from the photos it appears there is significant issues with the right side of the face and it is more than just asymmetry. A history as to how long it has been this way and what the onset was like would be helpful.  I suggest you get another opinion about the etiology. There are treatments but I am not sure medical problems do not exist

Solutions for Symmetry

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As long as a medical issue has been ruled out, there are options to improve facial symmetry. Fillers, implants, fat and sculptra will do very well for facial symmetry and sculpting. I suggest you see a cosmetic dermatologist with expertise. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 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.