Diagnosed with bellspalsy 11 years ago, now I have sykinisis. My eye closes when I smile. Will ptosis surgery help?

does Ptosis surgery (eye lid surgery) helps to make eyes look more normal when smiling, please help

Doctor Answers 5

How do I treat a drooping eyelid after Bell's Palsy

The change in your eyelid can be from abnormal activity of the nerve, which is best treated with Botox. If it is truly weakened or drooping, ptosis surgery may help as well.

Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 14 reviews

Eyelid closing after Bells palsy

Need photos and examination to tell you accurately but probably would benefit from Botox injection and/or ptosis surgery. See an oculoplastic specialist fr evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Facial recovery after Bells Palsy and synkinesis

Dear Richie

  • sorry to hear about your difficulty with your synkinesis after your recovery from facial nerve paralysis. 
  • The eyelid ptosis that you have is different from other causes, in that the eyelid closing muscles are now either misfiring or simple out of balance with the other facial nerve branches. 
  •  Traditional ptosis repairs would change lift the eyelid, but the muscle would still fire out of sync and likely you might have dry eye symptoms after such a repair. 
  • Consider a consult with a facial nerve center where we use small amounts of botox or other surgical treatments to balance your facial movements. 
  • you could also look into facial retraining with a therapist as well. They have shown excellent results with exercises and partner with facial plastic surgeons, ophthalmologists, oculoplastic surgeons and plastic surgeons to help manage this difficulty condition. 

Best Wishes

Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Ptosis surgery for synkinesis

sorry to hear about your troubles. In thinking about how to help your problem, we have to understand what the problem is. For whatever reason, you have an aberrant 7th nerve connection so that when you smile, your eye closes. Eye closure (and most of smiling) is generally innervated by the 7th nerve, whereas eye opening is innervated mostly with the 3rd nerve. Therefore, unfortunately, ptosis surgery will unlikely do anything for your synkinesis since it is working on a totally different set of muscles innervated by a different set of nerves. You may want to think about carefully directed Botox to your eye closing muscles instead. 

Lily Lee, MD
Pasadena Plastic Surgeon
5.0 out of 5 stars 28 reviews

Botulinum toxin is the key

When synkinesis develops after a facial nerve palsy the affected eye is smaller because it has excess stimulation of the closing muscle (orbicularis). Precise low dose botulinum toxin injection to block this excess stimulation works very well. Ptosis surgery would not be the answer. 

I would seek treatment with an ophthalmic plastic surgeon. 

Steven Couch, MD, FACS
Saint Louis Oculoplastic Surgeon
5.0 out of 5 stars 7 reviews

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