Do I Need a Specialist for Facial Synkinesis?
What is Facial Synkinesis?
Facial synkinesis is a neuromuscular disorder characterized by involuntary and incorrect simultaneous movements between muscles that occur during the healing process of nerves after facial paralysis. This condition manifests itself as uncontrolled contractions resulting from the incorrect branching of nerves that normally go to facial muscles that work independently of each other. In this context, symptoms such as involuntary closing of the eye when smiling, pulling of the corner of the mouth when blinking, and spasms in the cheek or jaw while speaking may be observed. Additionally, in synkinesia, not only appearance but also function may be affected; tension, spasms, stiffness, and unnatural facial expressions may occur in the facial muscles. Consequently, facial synkinesia is a significant condition that affects patients' social lives and self-confidence due to its aesthetic and functional effects. Therefore, it is crucial that it is monitored by experienced specialists in the field.
Why Does Facial Synkinesis Treatment Require Expertise?
Facial synkinesis treatment is a process that absolutely requires expertise due to both the complex anatomical structure of the facial nerve and the disease's unique course in each individual. For this reason, treatment requires a personalized assessment, accurate muscle analysis, and an experienced rehabilitation plan rather than a standard protocol. Furthermore, advanced treatment options such as botulinum toxin injections, selective neurolysis, and myectomy require a high level of clinical knowledge and experience to determine which muscles to intervene in and to what extent. Otherwise, incorrect applications by non-specialists can cause existing synkinesis to increase, facial asymmetry to become more pronounced, or muscle functions to weaken permanently. Therefore, it is crucial that facial synkinesis be evaluated by an experienced facial nerve specialist to ensure it is managed in the most accurate, safe, and effective manner.
Do I Need a Specialist Doctor for Facial Synkinesis?
If you are experiencing facial synkinesis, you must consult a doctor who specializes in this field, as this condition requires a different and more delicate approach than standard facial paralysis treatments. Since synkinesis occurs when muscles work together incorrectly due to improper nerve healing, detailed analysis of muscle activity is essential to plan the right treatment. It is crucial to accurately identify which muscle groups are overactive and which are weak. This analysis can only be performed by a specialist who is knowledgeable about facial nerve anatomy and experienced in synkinesis. Otherwise, botulinum toxin applications, manual therapy, or other interventions performed by non-specialists may exacerbate synkinesis rather than reduce it and may restrict facial movements. Furthermore, when it comes to advanced treatment options such as selective neurolysis, neurotomy, and myectomy, determining the correct indication and the safest method again falls within the area of expertise of a physician competent in this field. Therefore, the guidance of a specialist facial nerve doctor is of great importance for controlling and improving facial synkinesis and ensuring stable facial function in the long term.
The Importance of Choosing a Specialist Doctor for Facial Synkinesis
Choosing a specialist doctor for facial synkinesis is a critical factor that directly affects the success of treatment. Since synkinesis is a complex condition resulting from the improper healing of the facial nerve, different muscle groups are affected in each patient, and the symptoms vary from person to person. Therefore, a specialist who is knowledgeable about facial nerve anatomy, nerve regeneration processes, and synkinesis treatment protocols is required for accurate assessment, correct diagnosis, and the creation of a personalized treatment plan. Botulinum toxin applications, manual treatments, or surgical approaches performed by non-specialists can worsen existing synkinesis, cause new asymmetries, or permanently weaken muscle functions. In contrast, an experienced facial nerve doctor in this field correctly analyzes which muscles are overactive and which are weak; accurately plans botulinum toxin doses; and, when necessary, applies advanced treatment options such as selective neurolysis, neurotomy, and myectomy with appropriate indications. Therefore, choosing the right physician is crucial for ensuring natural-looking facial movements, preserving function, and achieving stable long-term improvement.
What Treatment Methods Does a Specialist Doctor Use for Facial Synkinesis?
There are specific treatment methods that a specialist doctor must apply for facial synkinesis. While some of these treatment methods are applied directly, others are auxiliary methods that improve deformities. Let's examine the treatment methods mentioned above;
Direct treatments for synkinesis:
Botulinum toxin
Specialist doctors administer botulinum toxin injections to reduce involuntary muscle contractions. This botulinum toxin method controls synkinesis without disrupting the face's natural expressions. Thus, patients both reduce the discomfort caused by involuntary muscle contractions and maintain a natural and balanced appearance in their facial expressions.
EMG-guided procedures
Electromyography (EMG) guidance is used to accurately identify which muscles are overworked or weak. This allows treatment to be planned by focusing on the correct muscles.
Face retraining exercises
The muscles are retrained using customized facial exercises and biofeedback techniques. This helps restore natural and balanced facial expressions.
Selective neurotomy / neurolysis
To reduce involuntary muscle movements caused by incorrect nerve connections, specific nerve branches are cut or released using microsurgery. This procedure is called selective neurotomy. Thanks to this procedure, patients experience reduced discomfort caused by involuntary muscle contractions, while maintaining a natural and balanced appearance in their facial expressions.
Selective myectomy
A portion of the excessively contracted muscle fibers is surgically removed. This method aims to reduce involuntary movements while preserving facial expression. Additionally, the selective myectomy procedure targets only the problematic muscles, preserving the function of the other facial muscles and reducing synkinesis without compromising the natural appearance of facial expressions.
(In special cases) Microsurgical nerve transfers
In some advanced cases, microsurgery is used to perform nerve transfer, creating new connections from a healthy nerve to the paralyzed muscles in order to restore facial movement. This allows the paralyzed muscles to receive stimulation again, and the patient's facial expressions are gradually restored.
(In special cases) Cross-facial nerve graft
Cross-facial nerve grafting after synkinesis or paralysis involves applying a nerve graft taken from the opposite side to provide a new nerve source to the paralyzed side. However, this method is only used in specific and suitable cases.
➤ Methods for correcting deformities after synkinesis:
Facial Sling Surgery
Specialist doctors perform facelift surgery on patients with asymmetry or sagging in the lower and middle regions of the face. This procedure balances the facial muscles and aims to preserve the natural, symmetrical appearance of the face. At the same time, facial sling surgery corrects age-related sagging of the face, allowing for more relaxed and balanced facial movements.
Gold Eyelid Weight
Gold eyelid weights are preferred, especially in patients who have difficulty closing their eyelids. Thanks to a small weight placed on the eyelid, the eyelid closes comfortably and the cornea is protected from potential hazards.
Asymmetric brow lift
It is applied in cases of unilateral brow drooping or facial asymmetry. This method restores symmetry to the upper part of the face and enables natural expressions. At the same time, the asymmetric brow lift procedure balances the muscles around the eyes, giving facial expressions a more harmonious appearance.
How Does a Specialist Doctor Plan Treatment for Facial Synkinesis?
When planning treatment for facial synkinesis, a specialist doctor first conducts a detailed assessment of the patient's facial muscles. This assessment examines both the overall symmetry of the face and daily facial expressions—such as smiling, talking, and blinking—in detail, documenting the movements with video recordings when necessary. Then, methods such as EMG (electromyography) are used to measure the electrical activity of the muscles to determine which muscles are overactive and which are weak. Based on this data, the doctor creates a personalized treatment plan; the muscles to be treated with botulinum toxin and the dosage are determined, and facial retraining exercises or biofeedback therapy are added to the treatment if necessary. Additionally, depending on the patient's condition, surgical options such as selective neurolysis, neurotomy, or myectomy are evaluated and applied in appropriate cases. Finally, throughout the treatment process, the doctor monitors the patient at regular intervals, observing muscle activity and facial movements, and revises the applications and exercise plan according to the effectiveness of the treatment. In this way, the specialist doctor aims to achieve the most accurate and safe results, both functionally and aesthetically.
What to Look for When Choosing a Specialist Doctor for Facial Synkinesis?
When choosing a specialist doctor for facial synkinesis, certain key points must be considered. In this context, the points to consider are as follows:
- The doctor must be an expert in facial nerve anatomy and complications following nerve damage. This requires them to have previously performed facial synkinesis treatments.
- It is important that they can correctly assess muscle activity and identify which muscles are overactive and which are weak.
- Attention should be paid to their ability to develop a plan specific to the patient's condition rather than relying on standard protocols.
- Attention should be paid to their sufficient capacity to perform advanced surgical procedures such as selective neurolysis, neurotomy, or myectomy.
- Ensure that they can explain the treatment process in a clear, understandable, and transparent manner. Also, pay attention to their ability to understand the patient's expectations and concerns and provide appropriate guidance.
What Happens If I Don't Get Expert Medical Help for Facial Synkinesis?
If you do not seek expert medical support for facial synkinesis, there is a risk of the condition worsening and permanent problems arising. Especially in synkinesis, where muscles work together incorrectly and involuntarily, incorrect or inadequate interventions can increase involuntary muscle activity, make facial asymmetry more pronounced, or restrict facial expressions. Furthermore, if the correct indication for surgical options such as selective neurolysis, neurotomy, or myectomy, which may be necessary in some cases, is not determined, unnecessary or incorrect applications can cause permanent impairment of muscle function. Consequently, treatments not planned by an expert facial nerve doctor can lead to negative aesthetic and functional outcomes and negatively affect the patient's social life and self-confidence. Therefore, it is crucial for individuals experiencing facial synkinesis to undergo treatment only under the supervision of an experienced specialist in the field.
