Botox treatment (or Dysport) for Facial Palsy and Bell’s Palsy for hyperkinesis and synkinesis

There are many people out there that have suffered from Bell’s Palsy.  This is a condition that causes the facial nerve to become weak so that you have a problem moving one side of the face.  In fact, it can be so bad that for a time, initially, the whole face will not move for several months and it can take months for it to come back.  After regeneration, you can have weakness on that side and also something called synkinesis where the muscles don’t act individually.  When you damage your facial nerve, when the nerve starts to grow back, it doesn’t always go to the correct muscles.  What happens is that the brain and the area of the brain that controls a certain area (say the left eyebrow and eye muscles of movement) will tell those muscles to contract and the nerve will travel from the brain to the muscles.  The problem occurs when the regenerating nerve travels to the wrong muscle when it grows back.  So some of the nerve fibers will travel to the mouth instead of the eye and eyebrow.  So when you want to move the eye and eyebrow, you also get some movement of the mouth.  This is called synkinesis.  Also when the weak side has a heard time moving as strong as the unaffected side, it will look different when a person smiles.  Botox can improve these situations to a degree.  Below I show where I inject botox and how many units in each area to decrease movement on the stronger side to get more symmetry.  You can change the amounts based on individual situations.  For the twitching you can place it on the weaker synkinetic side just enough to decrease that movement as well.  But this is much harder.

Thanks for reading, Dr Young

Dr Young specializes in Facial Plastic and Reconstructive Surgery and is located in Bellevue near Seattle, Washington

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