BOTOX for Facial Paralysis
Botulinum toxin (aka BOTOX) is one of the simplest yet most effective treatment for patients with facial tightness and synkinesis from chronic facial palsy. Botox works by blocking release of a neurotransmitter called acetylcholine, which is what nerves use to tell muscles to contract, or tighten. Hence, Botulinum toxin relaxes muscles which are too tight and can prevent involuntary facial movements, or synkinesis. While the Botox we use for facial palsy is the same medication that is used for cosmetic purposes (to decrease wrinkling with facial movement), insurance will typically cover Botox use for patients with facial palsy.
At the Facial Nerve Center, we are experts in identifying the facial and neck muscles where Botulinum toxin can be administered to improve facial symmetry, improve a patient’s smile, decrease synkinesis, and relieve tightness. We will help patients decide when to begin Botox during the initial consultation visit. We often recommend three or four physical therapy sessions PRIOR to Botox to help patients learn to use their facial muscles better before weakening certain muscles. We will then schedule patients to come in for a Botox visit. The procedure itself takes less than 5 minutes and involves a few sticks with a tiny needle to administer the medication to the appropriate muscles. The Botulinum toxin begins working 2-5 days after administration and the maximal effect is approximately 2 weeks after the procedure. Botox lasts 3-6 months, at which time we will see patients back to re-administer the medication and titrate the doses and muscles targeted, as necessary.
While patients with Bell’s Palsy usually make a complete recovery, 15-30% of patients will develop some degree of chronic facial palsy, and suffer from facial and neck tightness, and involuntary facial movements in one area of the face during facial expression (this phenomenon is called synkinesis). Other conditions such as Ramsay Hunt Syndrome, Lyme Disease, acoustic neuroma resection, and autoimmune disease can also result in long-term facial tightness and synkinesis. These problems arise from abnormal facial nerve regeneration after injury; rather than a lack of regeneration, the recovery can be disorganized or over-zealous.