Botox for Facial Paralysis

Conveniently located to serve Dallas and Plano, TX

Botox for Facial ParalysisIt is well-known that Botox can be used to treat wrinkles but it is less well-known that Botox can be used to manage an individual with facial paralysis, both temporary and permanent in nature. Facial paralysis can arise for many reasons: previous trauma, cancers like parotid tumors, acoustic neuromas, facial nerve tumors, etc., Bell’s palsy, previous surgery, or other neurologic conditions. Dr. Lam has a deep understanding of facial nerve and facial anatomy to provide the most sophisticated treatment for the individual with facial nerve paralysis. He has many patients who fly in or drive in from long distances for his expert handling of facial-nerve issues using Botox.

There can be many goals when using Botox to treat facial-nerve paralysis. Interestingly, in most cases Dr. Lam is injecting the “good side” with normal nerve function in order to reduce the motion on that side to better match the paralytic side. For example, when someone smiles, the good side will pull upward and the paralyzed side will not. Accordingly, by injecting a muscle known as the levator alaeque nasi (LAN) and occasionally also the orbicularis oris (OO) on the non-paralytic side, Dr. Lam can balance the two sides so that there is less of a disparity, making someone more socially normalized and acceptable when viewed. He also treats pain associated with some facial paralysis conditions. Finally, there is a condition known as synkinesis where on the paralyzed side moving one part of the face causes several areas of the face to move at once. For example, if someone is smiling, the eye may close or blink. These are the main ways that Dr. Lam treats facial paralysis.


When is it safe to treat a facial paralysis condition?

Usually, Dr. Lam treats facial paralysis when the condition has already matured and stabilized months or years after the initial injury or insult. However, it can be treated in most cases far earlier even when the initial injury occurs. Of course, if the injury is only recent and there is full recovery on the side of the injury, then the Botox may last longer than the injured side and cause an imbalance. That being said, it is generally safe to treat facial paralysis at any time from early to late in the course of the paralysis.

Are there any new breakthroughs with Bell’s Palsy?

Even though Dr. Lam does not treat the condition of Bell’s palsy, especially during the early phase to determine how to reverse or minimize the condition, he has learned that intravenous immunoglobulin (Iv IG) given within days of the onset may entirely reverse the Bell’s palsy condition. This valuable information may help those who have recurrent Bell’s Palsy or who know others who are beginning to suffer from this condition.

How does Dr. Lam balance a face with facial paralysis?

As mentioned in the introductory text to this page, usually Dr. Lam focuses on injecting the “good side”, that is, the non-paralyzed side to help with making the two sides appear more balanced. This is important both short term to make the face look more balanced not only in motion and still but also to manage long term the muscle bulk to be more symmetric as months to years go by. Botox can be an important part of making sure the face does not progressively become more imbalanced through lack of treatment.

How long does the result last? How often do I need to see Dr. Lam?

Usually, the short-term effect of Botox only lasts about 3 to 4 months. However, with repeated doses, the face may appear more balanced over time as mentioned in the previous FAQ answer above. If there is also some concurrent aging of the face, Botox will help flatten wrinkles and create a more youthful face in addition to all of its balancing potential, and as discussed on the page for Botox for wrinkles, there should be ongoing improvement over time.

How does Dr. Lam treat synkinesis?

Synkinesis from the Greek means simply “syn” = together “kinesis” = movement. The mass movement of the face occurs after a facial nerve injury where there is incorrect rewiring of the nerves so that trying to move one part of the face causes another part of the face to move simultaneously, which can be quite disfiguring. By putting Botox into the paralyzed side in a very precise manner, which are called “trigger points”, Dr. Lam is able to separate this movement with various levels of improvement without overly paralyzing the “bad side”. Near the mouth, there is a muscle called the buccinator that can be addressed to help reduce the spasm in this region. In addition, there is a trigger point near the lower eyelid that can separate the movement of the eyelid from the mouth without over reducing eyelid motion or tone. Getting this right requires a little bit of experimentation until Dr. Lam achieves exactly what your body needs, but in most cases he can significantly improve your condition even after the first attempt.

How does Dr. Lam treat facial pain related to facial paralysis?

Dr. Lam has literally invented this category, which you can review more in detail on his page Botox for pain. Unfortunately, sometimes Bell’s palsy may lead to certain types of facial pain that is not easily addressed. With Dr. Lam’s method, he is able to entirely or almost entirely extinguish the pain the second after the needle is removed and that improvement can stay for months. Sometimes with repeated injections, the improvement in painmay last longer and over time start to entirely resolve, although Dr. Lam cannot make that guarantee, as everyone is different.

Does insurance cover this treatment?

Unfortunately, not. Dr. Lam does not accept insurance. A good way to think of this treatment is that despite the negative of trying to balance your face for movement, the Botox, both short- and long-term, should help with improving a more youthful and attractive face, which of course Dr. Lam performs for patients who do not have paralysis. See the Botox for wrinkles page.
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See more Botox for Bell’s Palsy/Facial Nerve Paralysis Videos

At times, Dr. Lam will inject the “bad side”, i.e., the paralyzed side. The reason for this is a condition known as “synkinesis”. When someone moves on the partially paralyzed side, multiple branches of the facial nerve can pull at once making the individual look abnormal. For example, when one smiles, the eyelid may simultaneously blink or contract. It is important to visually determine where the problem is and to gauge how to soften the mass movement by targeting the muscle so that excessive, simultaneous movement is reduced.

Another element to designing the treatment tailored to a particular patient is to evaluate the non-dynamic, or static, face, i.e., the face when it is not moving. When a face is paralyzed, sometimes the lack of tonicity on that side can cause the face to sag over time. Dr. Lam then targets counterpulling muscles to elevate the face on that side. Or, at times, he will inject the good side to lower the over active muscle to balance it with the paralyzed side. For example, the depressor angulae oris (DAO) can be injected to raise the corner of the mouth but it can only be undertaken if the opposing muscle, the orbicularis oris, has some upward tone.

Furthermore, it is important not only to have a detailed map or guide for current treatment but also a plan that accommodates the developing facial changes that arise over the long run. Dr. Lam refers back to previous treatment strategies but always reassesses the situation because muscle tone and facial shape do change over time. In fact, he believes that Botox for the paralyzed patient is critical not only to provide a short-term benefit but also to guide the overall shape and tone of the face in the long run so as to provide improved long-term outcomes for individuals who suffer from facial paralysis.

The complexity of Botox treatment for facial nerve patients is very high and requires a skillful eye, a knowledgeable mind, and a gentle touch. Dr. Lam provides all three. Although Dr. Lam does not accept insurance for this treatments, he does offer the most superlative care that is predicated upon a deep understanding of facial anatomy matched with an artistic eye toward facial shaping and balance.

For more information on Botox for facial paralysis, please watch Dr. Lam’s virtual consultation

Your Botox for Facial Paralysis will be performed by Dr. Lam's surgery center located in Plano, TX.

His technique is great and i never have pain when he does my fillers and botox.


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For a consultation with Dr. Lam regarding whether Botox for facial paralysis would work for you, please email us at [email protected] or call 972.312.8188.

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