How long should I wait after having Bell’s palsy to start injecting my face with Botox and fillers?

Question

I’ve have Bell’s palsy for a few weeks now but was planning to get my cheeks and lips filled along with Botox for my forehead after I am healed. I am concerned that my nerves aren’t healed all the way or are sensitive or damaged from the disorder and don’t want to risk causing more damage.

Daniel Levy, MD · Answer

I agree with the opinion that a neurologist should clear you prior to getting Botox after having Bell’s palsy. I recommend waiting at least 3 months after resolution of your symptoms.  Good luck!

Oxana Popescu, MD · Answer

Hello and thank you for your question.

Please wait at least 6 months for injecting fillers. Some patients continue to recover even after this period. 
Best from Westchester County in NY.

Oxana Popescu MD

Julia Kerolus, MD, FACS · Answer

The vast majority of patients with Bell's palsy will recover completely within three months of onset. A small subset of patients have incomplete recovery of their facial nerve function. 
I recommend waiting until you have regained complete function of the facial nerve prior to any botox or filler injections. 
If you have not fully recovered in 3 months, you should be evaluated by an ENT or facial plastic surgeon with experience in facial paralysis so that additional work up may be done. In the event of incomplete recovery long-term, this would be the person best equipped to treat you. Botox actually plays a role in treatment of patients who have had incomplete recovery from Bell's palsy.

Alex Eshaghian, MD, PhD · Answer

Thank you for your question Mv0955. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.
It is difficult to make an assessment without a formal exam where the entire medical history is reviewed. However, I hope the information provided here is useful.The safety record of Botox is well established. The product has been used for over 20 years for a variety of treatments with minimal side effects. Botox is amongst the safest treatments for treating facial wrinkles.
  
While Botox is one of the safest treatments offered, there are some situations where it is not appropriate. These include anyone who has an allergy to any of the inactive ingredients or who has had an allergic reaction to any botulinum product including Botox, Dysport, Xeomin, or Myobloc. The safety and efficacy of Botox has not been established in women who are pregnant, trying to become pregnant, or breast feeding. Therefore, women in these categories are advised to wait until breast feeding is completed prior to having a Botox treatment. Botox should not be placed in the skin on the site of an infection. Those who are taking an aminoglycoside antibiotic, an anesthetic, D-penicillamine, antimalarials, or immunosuppressants should not be treated, nor should those who have undergone chemotherapy within the previous six months. It is important to avoid blood thinners before and after a treatment. These include both prescription and non-prescription medications such as warfarin (coumadin), aspirin, ibuprofen, alcohol, fish oil, vitamin E, and ginko biloba. Those with conditions that affect muscles and nerves such as amyotrophic lateral sclerosis (ALS or Lou Gehrig's disease), myasthenia gravis, or Lambert-Eaton syndrome should not undergo Botox treatments.Although Bell's palsy is not an absolute contraindication to having a Botox treatment, when a person has Bell's palsy it would make it difficult to evaluate to provide an appropriate dosage recommendation with Botox. If I had a patient with the concern described here I would recommend waiting until everything is resolved before having a Botox treatment and consulting with a neurologist about it.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.
  
After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.
  
Please consult with a doctor for specific recommendations. Good luck!

Seth Kates, MD · Answer

Thank you and thanks for your question.  You are asking a complicated question but stuff generally gets better relatively quickly after a first episode of Bell’s palsy.  It can take a few weeks to a few months.  I would try to be patient in terms of getting cosmetic treatments to counteract the effects of the palsy.  I guess if you want to get your lips done, it would be fine but waiting would also not be a bad idea.  Good luck with your decision.

Martin Ray, MD · Answer

Hello Mv0955,
The simple answer is to wait 6 weeks to 6 months, until all symptoms have recovered.
Medicine however is not always as simple as we think; in this situation there are new considerations, thanks to the advancements in our understanding and experience injecting Botox and dermal fillers.
The majority of people will have a good recovery. Unfortunately, some people are left with a long term weakness of the facial nerve. I have been treating patients who suffer from long term weakness with filler and Botox. The affected side may have volume loss and weakness in the muscle, and dermal filler can help support this loss of volume. Unaffected muscles of the face can often display an increase in tone and activity, particularly in the earlier phase of the palsy. Botox can be used to relax the overactive muscles. For the past 2 years I have been using filler and Botox in patients with Bell's palsy to effect myomodulation. Filler placed under the affected muscle may improve muscle strength, while Botox in opposing muscles will provide less resistance and assist in decreasing the affected muscles' relative strength. 
I have been getting wonderful, life changing results treating patients with residual palsy this way with filler and Botox.
It is plausible that Botox and filler utilized to promote myomodulation for the facial nerve in the acute phase of Bell's palsy could aid recovery. I have never tried this, nor do I know of anyone who has. We would need a team of high-level experts to consider the risk/benefit in a  treatment protocol for acute phase Bell's palsy.
When to start treatment should be a discussion with yourself, your neurologist or primary care physician, and an injector experienced in treating Bell's palsy. I wish you all the best!

Robert L. Kraft, MD, FACS · Answer

I would wait and confirm with your neurologist that treatment is acceptable as it can mask underlying symptoms.

Mark L. Mazow, MD, FACS · Answer

Bell's palsy is a post viral palsy of the facial nerve. It will typically resolve in six weeks.It is a diagnosis of exclusion. There are other causes of facial nerve palsy which need to be considered especially if the  problem does not resolve in six weeks. The concern about Botox especially is that it may make it difficult to evaluate your facial function if it is done before you are completely resolved. I would recommend that you not have any facial injections of Botox or filler until you are completely resolved and cleared by the Neurologist or ENT that is following you for this. If the palsy doesn't resolve in that time you will need a more extensive work up

How long should I wait after having Bell’s palsy to start injecting my face with Botox and fillers?

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