American Academy of Facial Plastic and Reconstructive Surgery
American Academy of Facial Plastic and Reconstructive Surgery

I have facial nerve damage casued by an accident when I was young, is there a facial reconstructive surgery you can recommend to correct it??

Question: I’m 30yrs Old,Had an accident when I was 8yrs old and in d process,a left facial nerve palsy occurred which made my mouth to shift to one side whenever I laugh or smile.I’ve undergone a neuro-surgery to correct it.Though,there’s an improvement but not exactly what I want.I want to know if there’s any facial procedure dat can b done to make ma mouth and lips straight again so dat it can come back to it’s normal position because I’ve lost my Confidence ever since the accident,I hardly smile in Camera because of it. Pls kindly tell me what to do and if u can refer me to any Facial reconstructive surgeon over there.Thank you for ur Understanding.

Answer: thank you for your submission. the one negative truth is that with any facial nerve injury that is permanent, there will never be a procedure that can entirely make the face work like normal. there are only degrees of improvement but always less desirable than you would like. i would recommend finding a qualified facial plastic surgeon who specializes in reconstruction of nerve damages to see what your personal options would be. the other thing that i have found that works very well is botulinum toxin (Botox, Dysport), which can help do the opposite which is to control the good side of movement so that the two sides are more symmetrical. in addition, sometimes nerves on the bad side can have something called synkinesis in which the nerves all move in clusters like if you smile you blink. BTX can soften the areas of synkinesis as well over repeated injections. hope that helps.

I’ve been thinking about getting Botox but…

Question: Do Botox injections hurt?

Answer: Injecting anything with a needle can cause mild discomfort but that all depends on the physician’s skills and use of ancillary methods to reduce discomfort.  Numbing cream can be used for the very sensitive patient or ice can also be applied immediately before injection to chill the skin and thereby anesthetize it.  Some doctors tend to vibrate the skin a bit before injection to help with discomfort.  Finally, something that I have done in my practice that has truly helped is to stop using preservative-free saline in the reconstitution.  It is simply unnecessary and causes undue burning sensation during injection.

I have a lot of wrinkles on my face and forehead.

Question: Would you recommend a facelift?

Answer: Facelifts really do not work to help wrinkles.  Facelifts are intended to help with sagging muscles like jowls and neck hanging.  Depending on how the surgeon defines “facelift” it can either describe a lift of just the lower face and neck or also to include the sagging cheek and/or brow region. 

Even though when you pull your face up with your fingers the wrinkles go away, this type of movement is really not indicative of what a lift can do.  I call this the “two-finger rule”, meaning when you lift with two fingers this really does not indicate what a facelift can achieve.

So how do we fix wrinkles?  We have to divide the wrinkles into two types:  static (not moving, present all the time) and dynamic (wrinkles only appear during movement like during smiling, frowning, etc.)  Dynamic wrinkles of the upper face (but rarely of the lower face) are managed with botulinum toxin (e.g., Botox) since neurotoxins block the upper face from moving so that dynamic wrinkles do not appear.  Recurrent and steady use of neurotoxins every 3 to 4 months can lead to ongoing diminishment of wrinkling even sometimes to the point that dynamic wrinkles do not appear as deep when the neurotoxin has completely faded away.  Also, steady use of neurotoxins can help even diminish static lines if they are not too deep.

With the occurrence over time of static wrinkles, neurotoxins can still help diminish them with steady application, as mentioned above.  However, sometimes sun-damaged skin with significant wrinkles may require chemical peels or laser resurfacing to help modify these types of wrinkles.  Wrinkles of the lower face are harder to manage a with a neurotoxin.