What Are the Most Effective Synkinesis Treatments Available to Patients?

Facial synkinesis affects individuals after Ramsay Hunt Syndrome or Bell’s palsy, as well as acoustic neuroma and trauma patients who have had their facial nerve severely injured, cut and/or sewn back together. Synkinesis essentially occurs anytime the facial nerve regenerates after an injury.  The nerves are functioning but the individual branches have re-wired incorrectly, therefore, the facial muscles are not moving in a coordinated manner resulting in smile and eyelid dysfunction. Fortunately, many safe, effective synkinesis treatments are available, and these include:

1. Selective Neurolysis

Selective neurolysis is a cutting-edge synkinesis treatment pioneered by Dr. Babak Azizzadeh, a globally recognized facial nerve surgeon who has been featured on the Oprah Winfrey and Dr. Oz Show. During selective neurolysis surgery, Dr. Azizzadeh selectively decreases the activity of nerves that counter the smile mechanism through a minimally invasive incision. He also releases the overactive platysma muscle; this muscle pulls the corner of the mouth down and prevents a synkinesis patient from making an appropriate upward smile motion. This further improves upward trajectory of the mouth and reduces synkinesis. Since the patient’s own facial nerve and muscles are now allowed to work in a more natural way, the smile mechanism improvement is natural, emotional and spontaneous without any evidence of “joker” smile so often associated with bad plastic surgery.

Dr. Azizzadeh developed selective neurolysis with a simple goal: to help patients improve their quality of life and non-verbal communication capabilities. Now, selective neurolysis enables synkinesis patients to do just that. Selective neurolysis helps synkinesis patients achieve the components of a natural smile. It is the first long-term treatment option for synkinesis patients, and to date, other smile reanimation procedures have been unable to match its results.

Synkinesis cannot be prevented, but the aforementioned treatments can be administered any time after a patient receives a synkinesis diagnosis – typically one year after the onset of the initial facial neve paralysis. Furthermore, the treatments can be used to address synkinesis months or years after an individual experiences Bell’s palsy or facial paralysis.

2. Botox

Botox reduces unwanted muscle activity and reduces excessive tension of various muscles around the eyes, cheeks and neck. It helps synkinesis patients create a more symmetrical overall facial appearance. Additionally, Botox has been shown to improve facial function and aesthetics for synkinesis patients.

Botox consists of a protein derived from botulinum toxin. It counteracts the effects of synkinesis by relaxing the facial muscles and preventing them from contracting. Thus, Botox limits unwanted muscle movements in the face and reduces tension in areas of the face that are hyperactive.

Botox is most effective in improving the narrowing of eyelids that is associated with synkinesis.  It is also very effective in reducing the tension of the platysma muscle which is the most superficial muscle of the neck.  Although Botox offers proven benefits for synkinesis patients, it is important to note that Botox injection results are temporary.  Botox treatments generally lasts up to four months, and synkinesis patients who want more long-lasting results should be evaluated for surgery.  Furthermore, although very effective around the eyes and neck area, Botox has limitations in improving the smile mechanism which is more effectively treated with surgery.

3. Neuromuscular Retraining (NMR)

NMR, also referred to as Neuromuscular retraining or physical therapy, is used to treat patients who are dealing with a facial nerve that has not healed properly or does not functional naturally. The goal of NMR is multi-fold.  First, NMR can help synkinesis patients improve facial muscle coordination. For example, a synkinesis patient’s eyes might narrow when he or she tries to smile. In this instance, the patient’s facial muscles are strong enough to make facial expressions, but the wrong facial muscle flexes out of sequence, resulting in distorted facial movements.

With NMR, synkinesis patients also learn which muscles are responsible for different facial expressions. NMR teaches synkinesis patients how to isolate their facial muscles so that they can activate the proper facial muscles to make the desired facial expressions and relax the facial muscles that are not supposed to be moving. NMR can also assist patient who have extensive tightness or “cramping” of various muscle to help reduce tension and improve muscle activity. As a result, NMR helps synkinesis patients make unified, symmetrical facial expressions.

NMR is a valuable part of many synkinesis patients’ treatment strategies. In some cases, synkinesis patients benefit from NMR on its own. Or, NMR can be used in combination with Botox injections and/or selective neurolysis.

Ultimately, NMR requires time, patience and dedication. Synkinesis patients often need daily NMR, and as such, it is important to work with an expert occupational therapist for maximum effectiveness. This ensures a synkinesis patient can learn the exact exercises to help him or her achieve the best-possible results.

Dr. Azizzadeh takes a holistic approach to treat synkinesis patients. He evaluates a synkinesis patient and discusses NMR, Botox and selective neurolysis. Also, Dr. Azizzadeh teaches synkinesis patients about each of these treatment options and helps patients determine the best course of action. To find out more about synkinesis treatments, please contact The Facial Paralysis Institute today at (310) 657-2203 to schedule a consultation with Dr. Azizzadeh.