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’m interested in cosmetic injections

Question: How often do I need cosmetic injections after the first injections?

Answer: This really depends on so many factors.  First, areas of high mobility like the lips, smile lines, and areas around the mouth tend to suffer from absorption more readily than areas that are less mobile like the cheeks, under eyes, and temples.  Secondly, it depends on what products you are using, as some products have longer lasting timeframes in one’s body than others.  Third, it depends on how much product was placed, as placing more product may lead to relative persistence of the remaining product compared with placing very little product there. Fourth, it depends on your body’s metabolism of the product.  I have seen individuals hold products for years whereas other hold it for only a few months.  Variability truly sits with the individual person.  Speaking with your facial plastic surgeon who does your injections can help you determine based on all these factors what the likelihood of your product lasting a certain amount of time would be.

I’ve been reading about cosmetic injections and I wanted to know…

Question: Are cosmetic injections permanent?

Answer: Some cosmetic injections can be permanent; others are temporary.  Most common cosmetic injections like hyaluronic acid (Restylane, Juvederm) are temporary injections.  However, silicone microdroplets can be used for permanent corrections, most commonly for lip augmentation and acne scarring.  However, this method is considered “off-label” as it is FDA cleared for retinal detachments.  Using silicone safely is based on a discussion with a specific doctor’s philosophy and experience.  Another permanent injectable is polymethylmethacrylate (PMMA), marketed as Artefill.  A certain percentage of this product is made of bovine (cow) collagen that is partially absorbed and used as a vehicle for delivery of the product to ensure that it is smooth and does not migrate.  Finally, fat grafting can be considered a permanent injectable by those who are experienced at delivering fat.  If fat is not placed in small microdroplets it can look lumpy.  Since it is truly a “graft”, it needs blood supply to survive.  In experienced hands fat transfer is permanent minus a small percentage that can be absorbed.  There are other permanent injectables that are approved for use outside of the United States but that are illegal for use in the U.S.  Since this Academy is a U.S. based organization and the author of this post is from the U.S., I shall refrain from commenting on the safety, limitations, and efficacy of these other non-approved products.

I am 35 years old and have a lot of facial wrinkles.

Question: Would Botox be a good alternative to a facelift?

Answer: Yes, absolutely.  Botox, or neurotoxin, is the preferred method to manage facial wrinkles of the upper face.  Facelifts really do not offer any benefit to wrinkles since a facelift is used to lift and suspend sagging of underlying facial muscles.  With repeated injections of Botox, the facial muscles of the upper face start to relax, and the skin begins to heal.  Long-term neurotoxins are so powerful in terms of their ability to help you with helping skin have better texture, tone, and fewer wrinkles.  Early-on consistency is the key so that over time you need less Botox.  The earlier you start the better.  If you wait until wrinkles get very deep, it takes longer to heal the skin.

I’ve been looking into wrinkle treatments.

Question: Which is the best injectable for facial wrinkles?

Answer: The problem with this question is to divide wrinkles into static (non-moving) and dynamic (moving) wrinkles.  Another way to categorize wrinkles is to focus on upper versus lower facial wrinkles.  The upper face tends to have more dynamic wrinkles and the lower face tends to have more static wrinkles like the smile lines between the nose and the sides of the mouth.  For dynamic wrinkles, neurotoxins (like Botox) are truly the preferred way to address them in many cases since the neurotoxin helps to target the cause (movement) rather than the effect. By blocking bad habits like frowning, over time the skin will heal and the wrinkles start to diminish.  When the wrinkle gets very deep and you are impatient for the neurotoxin to work, then additional fillers may help but with the thin skin of the upper face, fillers may not be the ideal way to go.  With the lower face, neurotoxins carry the risk of speech problems if done in the wrong areas so in general lower facial folds and larger wrinkles are better candidates for injectable fillers.  Which filler is best?  That all depends on a conversation with your treating surgeon.  Why he would prefer one filler over another based on ability to fill a certain wrinkle characteristic, longevity, permanence, ease of correction if there is a problem with the filler, etc.  He would be better to counsel you on your specific type of wrinkle and his experience level with treating that wrinkle with a certain type of filler.