Synkinesis Treatments

Synkinesis refers to the development of facial movements that were not intended and it often affects individuals who are recovering from facial palsy for an extended period of time. Selective Neurolysis is the best surgical treatment in most patients with partial facial paralysis and synkinesis. Pioneered by Dr. Babak Azizzadeh, Selective Neurolysis is the most cutting-edge treatment option for patients and provides effective and long lasting results.

Treatment Options for Synkinesis

Treatments are usually based on three modalities:

1. Synkinesis Surgery: May consist of selective neurolysis (also known as modified selective neurectomy), static suspension of the corners of the mouth, blepharoplasty (eyelid surgery) or an asymmetric facelift treatment.  Selective neurolysis serves as a complex, intricate synkinesis treatment with a minimal recovery period.
2. Neuromuscular Retraining (physical therapy): Focuses on retraining the coordination of appropriate facial muscle movements. Neuromuscular training involves the identification of facial muscles that are contracting abnormally, along with a multi-stage process that enables an individual to retrain the facial muscles at the neurological (brain) level.
3. Botox (botulinum toxin): May be used by itself or in combination with selective neurolysis or neuromuscular retraining. Botox for synkinesis can reduce muscle activity, limiting the risks associated with overactive and uncoordinated muscles.

It is essential for an individual to review all of these facial synkinesis treatment options during a consultation with a facial nerve expert, like Dr. Azizzadeh. By doing so, a person can learn about the benefits associated with each treatment and determine which treatment option will provide the best results for their unique concerns.

When a patient has tried other methods, but is not experiencing success, surgery may be the best option. Babak Azizzadeh, MD, FACS is a world-renowned facial paralysis surgeon who will customize a surgical treatment plan to address your facial nerve synkinesis concerns. These treatments are innovative surgical procedures that have been developed at the Facial Paralysis Institute. Traditionally, static slings, blepharoplasty, and face/neck lifts were utilized to improve symmetry. Today, procedures such as selective neurolysis and gracilis flaps/cross facial nerve grafts can restore a dynamic smile.

Selective Neurolysis Surgery for Synkinesis

Selective neurolysis is the most cutting-edge advancement in the treatment of patients who cannot generate an appropriate smile with partial facial paralysis and synkinesis. This is an intricate operation, but the downtime and risks involved for the patient are limited compared to other facial nerve surgeries. The procedure involves releasing the platysma muscle (which pulls the corner of the mouth down, hence preventing upward smile motion) and selectively decreasing the activity of the nerves that counter the smile mechanism to help get an upward trajectory of the mouth and improve synkinesis. That way, the procedures allow spontaneous reanimation of the face.

The benefits of selective neurolysis include:

• Enhanced facial symmetry
• Improved facial muscle coordination
• Reduced facial muscle tightness

Additionally, selective neurolysis is a one-stage surgery. Whereas some smile reanimation procedures deliver results that become visible within two to three years of treatment, selective neurolysis produces results that can be seen as soon as one day following surgery.

Synkinesis Surgery Before and After Photos

Check out the photos below to see how past patients have benefited from synkinesis procedures performed by Dr. Azizzadeh.

Static Suspension for Synkinesis Treatment

Static suspension, or static sling, is a procedure used to improve facial symmetry in patients with facial paralysis and synkinesis, particularly in the mouth and laugh line area. Plus, static sling has been shown to help an individual minimize some of the most difficult side effects of facial paralysis, such as drooling and biting of the inner gum.

Dr. Azizzadeh uses sutures or tensor fascia lata (autologous tendon) from the patient’s outer thigh. If tensor fascia is utilized, strips of the tendon are attached to the corner of the mouth on the through a small facelift incision. Dr. Azizzadeh uses endoscopic technology to minimize the quantity and size of incisions, and he is an expert in performing static suspension surgery using the tensor fascia lata. Because the muscle used to create the sling is from the patient’s own body, there is less chance of rejection.

Another option for static sling surgery is to use freeze-dried, acellular human dermis known as Alloderm. Dr. Azizzadeh has experienced great success with Alloderm over the years and a benefit to this procedure is that there is no need for a second incision to get muscle to harvest, such as in the leg for the tensor fascia lata procedure.

Dr. Azizzadeh can also perform a minimally invasive suture suspension procedure in place of the more invasive surgery, which may be a good option for patients with partial synkinesis. Each patient is unique and the most appropriate treatment method for your particular condition will be decided upon during your consultation.

Blepharoplasty for Synkinesis Treatment

One of the most common side effects of synkinesis and partial synkinesis is involuntary eyelid closure when smiling, laughing, or opening the mouth. In some cases, this can be treated with a modified blepharoplasty, or eyelid surgery. Depending on your unique situation, Dr. Azizzadeh can customize a treatment plan to help restore normal eyelid function and address your specific needs.

Asymmetric Facelift for Synkinesis

Dr. Azizzadeh can also perform an asymmetric facelift and/or neck lift to improve facial symmetry and minimize the visible effects of facial paralysis and synkinesis. He tailors the facelift to the individual in order to address specific areas affected by synkinesis and obtain optimal aesthetic results.

Dr. Azizzadeh, known around the world for his facial reanimation expertise, performed a facelift on Mary Jo Buttafuoco in 2005 as part of the specialized treatment plan he created to restore balance and animation to her face after she had been shot in the head years earlier. The facelift, performed in conjunction with static facial suspension and a modified blepharoplasty, produced incredible results, both in terms of function and aesthetics.

Cross Facial Nerve Graft & Gracilis Muscle Transplant

Some patients with long-term facial paralysis and synkinesis may be candidates for a cross facial nerve graft and gracilis muscle transplant. These cutting-edge surgical procedures, combined with physical therapy, can help restore dynamic facial animation, such as the ability to smile, in facial paralysis patients.

The procedure is typically done in two parts. First, nerve grafts from the lower leg are harvested and fixed to the functioning facial nerve in what is known as a cross-facial nerve graft. The second stage is the gracilis muscle transplant in which a portion of the gracilis muscle free flap from the inner thigh is harvested and attached to the cross-facial nerve graft. Together, these two procedures and physical therapy typically restore some facial movement within 8 months, and patients continue to see improvement for up to two years.

Synkinesis FAQs

Are facial paralysis and synkinesis identical?

There is a lot of confusion about facial paralysis and facial synkinesis. Facial paralysis refers to the paralysis of one side of the face. In this instance, the nerves and muscles on one side of the face do not work or move at all. Comparatively, with synkinesis, the nerves have regenerated incorrectly. Dr. Azizzadeh refers to this as a mis-wiring because when the patient tries to smile, the wrong muscles are activated and are counteractive to a “normal smile.”

Are Bell’s palsy and synkinesis identical?

Bell’s palsy is a primary cause of facial paralysis in the United States. It results in immediate facial paralysis that generally disappears on its own within about three months of an initial diagnosis. Comparatively, synkinesis may occur after Bell’s palsy.

If a person experiences sudden facial paralysis, he or she should go to an emergency room immediately. In this instance, an individual can meet with a doctor and may receive a Bell’s palsy diagnosis.

If a Bell’s palsy patient’s facial paralysis lingers for eight months or longer, a consultation with Dr. Azizzadeh is key. At this point, Dr. Azizzadeh can analyze a Bell’s palsy patient and find out if he or she is dealing with synkinesis. Then, he can craft a custom treatment to address the patient’s facial paralysis.

What are the symptoms of synkinesis?

An individual who is dealing with synkinesis may experience increased facial muscle tone, short, tight facial muscles, unwanted facial movements and facial movement coordination issues. Other signs of synkinesis include narrowing of the eye affected by facial paralysis, increased facial muscle spasms, dimpling of the chin and tightness of the neck bands and cheeks. Synkinesis symptoms often vary depending on the patient and the severity of his or her condition.

Synkinesis patients may also develop distinct facial muscle patterns. For example, a synkinesis patient’s eye may inadvertently close or twitch when he or she smiles. Or, simultaneous facial muscle movements may cause the corner of a synkinesis patient’s mouth to droop, making it difficult for him or her to smile.

Does synkinesis affect the entire face?

Synkinesis often affects the eyes, cheeks, chin and neck. For synkinesis patients, muscles in these facial areas are difficult to move. As such, synkinesis patients may experience facial twitching and tightness of the facial muscles, among other symptoms.

Is there a one-size-fits-all solution to treat all synkinesis symptoms, at all times?

Every patient we see has a unique case and therefore our treatments are always customized to the needs of each individual patient. To determine the best treatment, Dr. Azizzadeh performs an in-depth patient evaluation prior to recommending a treatment. This evaluation allows Dr. Azizzadeh to assess patient and determine which treatment option will help a patient alleviate his or her synkinesis symptoms.

Is synkinesis preventable?

Synkinesis is not preventable, but those who believe they are dealing with synkinesis symptoms can act quickly to minimize their impact. Because the sooner a patient seeks out an expert facial plastic and reconstructive surgeon like Dr. Azizzadeh, the sooner he or she can alleviate these symptoms.

How is synkinesis diagnosed?

During an in-person consultation or video inquiry, Dr. Azizzadeh will as the patient to make a series of facial movements. He will watch and evaluate their facial movements to determine the type of synkinesis that is occurring. Once Dr. Azizzadeh determines what nerves and muscles are causing the synkinesis, he then develops a treatment plan for this individual.

What should I expect during a synkinesis consultation?

Dr. Azizzadeh understands that each patient is unique, and as such, no two synkinesis treatments are exactly the same. To assess a patient, Dr. Azizzadeh learns about a patient and his or her symptoms and evaluates their facial movement capabilities. Dr. Azizzadeh provides a treatment recommendation tailored to an individual’s synkinesis symptoms. He also responds to a patient’s synkinesis concerns and questions and ensures this individual feels confident about treatment.

How long does it take to administer a synkinesis treatment?

The length of time to administer a treatment varies depending on the procedure. Fortunately, Dr. Azizzadeh provides full details about what a patient should expect during treatment so he or she can prepare accordingly.

How long does it take to see the full results of a synkinesis treatment?

The amount of time before a patient sees the full results of a treatment varies. Dr. Azizzadeh helps each patient plan for a synkinesis treatment. For example, Botox for synkinesis takes about 7 – 10 days to see the results, whereas results from selective neurolysis for synkinesis can be seen in as little as 24-hours post surgery.

What will happen if synkinesis goes untreated?

Synkinesis symptoms may worsen over time. If a person has experienced facial paralysis for at least eight months, a treatment consultation with Dr. Azizzadeh is ideal. By meeting with Dr. Azizzadeh, a patient can receive expert support so he or she can permanently address facial paralysis symptoms.

Contact Us Today to Discuss Synkinesis Treatment Options

Every synkinesis patient is different, and therefore, treatment methods may vary from one person to the next. Generally, patients experiencing permanent or partial synkinesis will go through physical therapy to help restore facial movement, and/or Botox injection treatments to improve facial symmetry. If these are not effective, you may be a candidate for surgery.

Dr. Babak Azizzadeh is a world-renowned facial paralysis surgeon who has extensive experience in treating patients suffering from facial synkinesis, both surgically and non-surgically. He is a Harvard-trained and double board-certified facial plastic and reconstructive surgeon who is happy to help individuals find ways to manage synkinesis.

If you are suffering from synkinesis, schedule a consultation with Beverly Hills surgical expert Dr. Azizzadeh by calling (310) 657-2203 or sending us an email.

Next, read about Botox for synkinesis treatments.