Bell's palsy- residuals and synkinesis.

Question

I had bells palsy on june 9, 2016. I am at 8 mon. Eye closes on yawning, left eye smaller. I am seeing facial physiotherapist since Dec. She started with massages, heat and stretches which has helped to reduce the tightness of muscles and reduce tinnitus. I have also started with few exercises lik smile, pucker, partial eye closure and smirk. How long should I practice the exercises or should I go for botox right. away. I am desperate to get my smile. Should I expect improvement with exercises.

Jeff Markey, MD, FACS · Answer

Ideallly, Botox is started after there are few additional changes to the face. For Bell’s palsy this is often 4-6 months after the initial onset. There is some evidence that Botox performed during recovery may be helpful, but this is not fully clarified and is not performed in most practices. Physical rehabilitation is the first line treatment, and then Botox should be administered by a Facial plastic surgeon once a plateau has been reached regarding improvement during rehab sessions. You should notice improvement each week with effective rehabilitation.

Callum Faris, MD · Answer

Thanks for the question. The first line treatment with synkinesis is physiotherapy. Second line is Botox. Most patients who require physiotherapy for synkinesis will go on the have botox as well. We do not know the answer as to when the best time to start Botox is, and practice varies between centers. I would mention that if you have had a facial palsy and you have one sided tinnitus, I would recommend you see an ENT surgeon for a full examination. I hope this helps

Michael P. Morrissette, DDS, FACS · Answer

Thank you for your question. You can receive Botox treatment now to help improve your appearance until your Bell's palsy resolves. Since this condition can resolve spontaneously, I would not recommend any surgery at this time.

Brent Moelleken, MD · Answer

There are many, many procedures and injectables that can be done to minimize the effects of Bell's palsy.  These range from Botox injections to asymmetrically performed surgeries, muscle slings, etc.  You may want to consult with a plastic surgeon who is skilled in all of your possible options, from nonsurgical to surgical.

Jason Emer, MD · Answer

Botox can be used to fix an asymmetry. I recommend following up with your Doctor about their recommendations for recovery and timeline. Technique will be important, so you'll want to see someone meticulous. I also suggest getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Hardik Soni, MD · Answer

Thank you for your question. Yes, Botox can be used to fix asymmetry. It is best to have a follow up with your doctor to determine your recovery and timeline. I recommend seeing an expert injector as technique is carefulness is important. Best of Luck!

Robert S. Schmidt, MD · Answer

Thanks for your question. Sorry to hear you're having so much trouble. Unfortunately when people have a severe case of Bell's, they can end up in your situation. Botox can be helpful in reducing synkinesis and spasms. However, I think for your long-term prognosis, continuing with facial exercises will be very helpful. Make sure you're doing them in front of a mirror. There's something about the visual feedback that really seems to help. Improvement can be expected for one to two years following onset. Good luck!

David Alessi, MD - Account Suspended · Answer

Botox during the recovery phase is very useful.  We have a large experience with facial palsy patients and have found precisely placed Botox will reduce the tightness and asymmetry.  Best wishes,

Bell's palsy- residuals and synkinesis.

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