Treatment Options for Facial Synkinesis: From Therapy to Surgery

If you've been dealing with facial synkinesis, you're probably wondering: what can actually be done about it? The good news is that you have more options than you might think. From gentle therapies you can start right away to more advanced surgical procedures, there's a whole spectrum of treatments designed to help you regain control and confidence.

Let's walk through your options together, so you can make informed decisions about what might work best for your unique situation.

Starting Simple: Non-Surgical Treatments

Most doctors recommend starting with conservative treatments first. Think of it as testing the waters before diving into the deep end. These approaches are less invasive, have fewer risks, and often provide significant relief on their own.

Physical Therapy: Retraining Your Face

Facial physical therapy might sound unusual, but it's actually one of the most effective first steps you can take. This specialized therapy, called neuromuscular retraining therapy (NMRT), is like going to the gym for your face.

Here's what you can expect:

• Patient education about how your facial muscles work

• Targeted exercises designed specifically for your condition

• Facial massages to improve muscle function

• Biofeedback training using mirrors or special equipment to help you see what your muscles are doing

The beauty of this approach is that it teaches your brain to communicate better with your facial muscles. Many patients see improvements in facial symmetry and gain better control over unwanted movements. Even better, the benefits often last long-term, giving you tools you can use for life.

Botox: Your Quick-Relief Option

You've probably heard of Botox for cosmetic purposes, but it's also a game-changer for synkinesis. It's typically the first medical treatment doctors recommend, and for good reason.

Botox works by temporarily relaxing overactive muscles that cause those unwanted facial movements. Your doctor will strategically place small injections in specific areas – maybe along your eyelid or on the unaffected side of your face to create better balance.

The benefits are pretty impressive:

• Quick results – you'll usually see improvement within a week to 3 weeks

• Minimal downtime – most people return to normal activities right away

• Reversible effects – if you don't like the results, they'll fade in 3-4 months

• Low risk – serious complications are rare when performed by experienced professionals

The temporary nature of Botox is actually an advantage. It gives you and your doctor a chance to see how you respond and plan any future treatments accordingly.  However, the injection pattern for synkinesis is different to the approach taken in aesthetics clinics.  It is advisable to see an injector with experience in treating synkinesis.

When Surgery Becomes an Option

Sometimes, non-surgical treatments aren't enough on their own. If you've tried therapy and Botox without getting the results you want, or if your synkinesis is severe, surgical options might be worth considering.

Depressor Anguli Oris Excision

This procedure makes a cut inside the mouth and cuts a muscle that turns the corner of the lip down.  This muscle only really has the purpose of frowning and often its affected in synkinesis.  Overactivity of it causes distortion of the smile.  The procedure is simple and can be done under local anaesthetic (numbing injections).

Other Selective Myectomies

There are other muscles that can be cut too to remove their overactivity.  For example a part of the muscle that closes the eyelid, to allow the eye to open better.  All these approaches are customised to the individual patient. Usually it will help the botox treatment work better.

Selective Neurolysis: Precision Nerve Work

This procedure sounds more intimidating than it actually is. Selective neurolysis involves carefully trimming problematic nerve branches that are causing unwanted muscle contractions.

During the surgery, your surgeon will:

1. Identify problem areas by stimulating nerve branches

2. Remove only the troublesome branches while preserving main nerve pathways

3. Test muscle function to ensure important movements are maintained

The goal is to stop the twitching while keeping your ability to make normal facial expressions. It requires a skilled surgeon who understands the delicate balance between controlling symptoms and maintaining function.

Symmetry Procedures: Balancing Your Face

Sometimes the best approach is to create balance by working on both sides of your face. Symmetry procedures help anchor facial features in place and can involve destroying function in muscles that aren't essential for daily activities.

For example, your surgeon might combine a brow lift with targeted nerve work in your forehead area. This creates a more balanced appearance without requiring complex nerve reconstruction.

Other Surgical Options

Depending on your specific needs, your surgeon might recommend:

• Brow lifting to address forehead asymmetry

• Upper eyelid surgery to improve eye function

• Muscle transfer procedures for more complex cases

Each option is tailored to address your particular combination of symptoms and goals.

The Power of Combination Therapy

Here's something important: you don't have to choose just one treatment. In fact, the most successful outcomes often come from combining different approaches.

A typical combination might include:

• Physical therapy to retrain your muscles

• Regular Botox treatments to manage symptoms

• Surgical procedures to address specific problem areas

This team approach makes sense because each treatment tackles the problem from a different angle. Botox provides quick relief, therapy gives you long-term control, and surgery can fix structural issues that other treatments can't address.

Many patients find that combining Botox with facial therapy is particularly effective. The Botox creates a "window of opportunity" where your overactive muscles are relaxed, making it easier to focus on retraining during therapy sessions.

Choosing the Right Path for You

So how do you decide which treatment is right for you? Here are some factors to consider:

Start with your symptoms: How severe is your synkinesis? Are you dealing with mild twitching or more significant facial imbalance?

Consider your lifestyle: Do you need quick results, or can you invest time in longer-term therapy approaches?

Think about your comfort level: Are you ready to explore surgical options, or would you prefer to start with non-invasive treatments?

Evaluate your previous experiences: Have you tried any treatments before? What worked and what didn't?

Remember, treatment often progresses from simple to more complex. Most doctors recommend trying conservative approaches first, then considering surgery if needed.

What to Expect During Treatment

Every treatment journey is different, but here's what you can generally expect:

Initial consultation: Your doctor will evaluate your specific condition and discuss all available options with you.

Treatment planning: Together, you'll develop a personalized plan that might involve one treatment or a combination of approaches.

Regular follow-ups: Whether you choose therapy, Botox, or surgery, you'll have regular check-ins to monitor progress and adjust your treatment as needed.

Patience with results: Some improvements happen quickly (like with Botox), while others take time (like with physical therapy or healing from surgery).

The Importance of Finding the Right Team

One of the most important decisions you'll make is choosing the right medical team. Look for professionals who:

• Specialize in facial nerve disorders

• Take a comprehensive, multi-disciplinary approach

• Listen to your concerns and goals

• Explain options clearly without pressuring you

• Have experience with the specific treatments you're considering

At Ullas Facial Plastic Surgery, we understand that dealing with facial synkinesis affects more than just your appearance – it impacts your confidence, your daily activities, and your overall quality of life. That's why we take a personalized approach to each patient's care.

Moving Forward with Confidence

The journey to managing facial synkinesis isn't always straightforward, but you have more options today than ever before. Whether you start with gentle physical therapy, explore the quick relief of Botox, or eventually consider surgical solutions, the key is taking that first step.

Remember, you don't have to figure this out alone. The right medical team will guide you through your options, help you understand what to expect, and support you every step of the way. Your condition is treatable, and with the right approach, you can regain both function and confidence in your facial expressions.

Ready to explore your treatment options? The first step is scheduling a consultation to discuss your specific situation and goals. Together, we can develop a plan that's tailored just for you.