Botox for synkinesis after bells palsy - how long should I wait before treatment & will synkinesis get worse?

Question

I developed bells palsy 6 months ago after having my daughter. I have regained most of the movement on my affected side but have been left with synkinesis. I am wondering how long should I wait before treating this with botox? Also I started noticing synkinesis symptoms at around 4 months it hasn't gotten much worse to look at but it feels slightly worse. I am wondering does synkinesis continue to get worse over time instead of better?Thank you.

Jose Telich, MD · Answer

Hi, I am sorry to hear that you are currently battling with synkinesis.

Synkinesis can cause unintended muscle movements when attempting to make a different facial expression. For example, smiling might involuntarily lead to eye closure or eyebrow raising. Treatment protocol usually starts with rehabilitation and physical therapy, followed by botox application in the synkinetic area, as well as some botox in the healthy side of the face to balance facial expressions and give a more symmetric look. Severe and incapacitating cases may need surgical procedures such as myotomies or selective neurectomy.

I advice you look for a surgeon experienced in peripheral nerve surgery and facial palsy reconstruction. Best wishes.

Eric M. Joseph, MD · Answer

After facial nerve paralysis, synkinesis is when there is abnormal motor function of the Muscles of facial expression on the side of the paralysis. Since most of the movement on the affected side is back, you are probably seeing a final result. Some might say that your final facial nerve function would be seen between 12 and 18 months. Botox can be Considered for treating synkinesis when it is involving the muscles in the upper 1/3 of your face. If the muscles of your forehead and eyes are the issue, Botox may be considered for treatment of both sides of your face symmetrically. If the muscles of facial expression in the lower 2/3 of your face are involved, Botox would not be helpful since it may impair your ability to smile properly. I hope this helps and good luck with the baby. Sincerely, Dr Joseph PS Some say that the Mona Lisa displays Bell's palsy from pregnancy...

Leonard Grossman, MD · Answer

In the patients that I have seen that presented to me with Bell’s palsy, I always recommend that they give themselves a full 12 months of recovery and therapy if possible to help the recovery. If you desire, you can have some of the opposite side of the face treated with Botox, but do so very, very carefully in the hands of a plastic surgeon. I hope this helps and good luck from New York City Plastic Surgery.

Botox for synkinesis after bells palsy - how long should I wait before treatment & will synkinesis get worse?

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