Archive for the ‘It’s All About Facial Paralysis’ Category

Using Botox To Treat Facial Synkinesis

Thursday, April 18th, 2013

Beforeafterbotoxfacialsynkinesis 300x152 Using Botox To Treat Facial SynkinesisAs a facial plastic surgeon in Charlotte with a unique training and knowledge in treating facial paralysis and Bell’s palsy, I’d like to let my patients know about a great treatment that can be used to help create facial balance after an episode of Bell’s palsy—Botox.

What Is Facial Synkinesis?

Facial synkinesis in Charlotte occurs after an episode of Bell’s palsy when the patient doesn’t regain full facial movement. Synkinesis is the inability to coordinate the individual muscles of half of the face.  It results in a wide range of both functional and aesthetic changes.  Common changes include:

  1. Narrowing of the eye during smiling

  2. Asymmetry of the smile

  3. Dimpling of the chin

  4. Asymmetry of the forhead

  5. Pulling sensation in the neck

For my patients in Charlotte, Synkinesis can have a negative impact on the quality of life and of a patient’s self image. Botox is excellent and the best method to improve the function and the appearance of the synkinetic face.  It is injected to muscles on both sides of the face to increase facial symmetry at rest and during animation.  It can be used to open a narrowed eye, soften the smile, and relieve the pulling senstation just to name a few of the positive effects of Botox used to treat facial synkinesis.

What Is Bell’s Palsy?

Bell’s palsy is a disorder of the facial nerve that brings facial paralysis to one side of the face. Unlike other forms of facial paralysis, the cause of Bell’s palsy isn’t entirely understood, though many medical professionals believe it to be a result of a virus affecting the facial nerve. When the facial nerve becomes inflamed, the necessary neural input is blocked which prevents movement of the facial muscles.  Initially, Bell’s palsy in Charlotte is commonly treated with anti-virals and steroids. In nearly 90% of patients affected with the condition, facial movement is regained over the course of the following months after diagnosis, though it’s difficult to pinpoint exactly when the condition will run its course.

Contact Carolina Facial Plastics Today

As a board certified head and neck surgeon with a special training in facial plastic and reconstructive surgery, I’m able to provide my patients with an ideal knowledge of both the function and aesthetics of the face. If you’re suffering from synkinesis as a result of Bell’s palsy, I encourage you to contact my medical practice in Charlotte today to schedule your initial consultation by calling (704) 323-5090. Using Botox has proven time and time again to be successful for my patients, and I’m confident that I can help you achieve a more symmetrical smile as well.

For additional information about undergoing Charlotte Botox treatments to treat facial synkinesis for Bell’s palsy, please contact my office today.

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Green Bay Packers Player Diagnosed with Bell’s Palsy

Monday, August 13th, 2012

Green Bay Packers player, Jarius Wynn, was at dinner when all of a sudden his eye began to water and soon after he was not able to close his eye.  Wynn was diagnosed with Bell’s palsy.  Bell’s palsy is a paralysis or weakness of the muscles on one side of the face.  In Bell’s palsy patients, damage to the facial nerve occurs that controls muscles on one side of the face, which then causes that side of the face to droop.  An individual’s sense of taste, production of tears and saliva may also be damaged.  It is very common that the condition comes on suddenly, often overnight.  Dr. Babak Azizzadeh, facial paralysis specialist, and my fellowship director, commented on Wynn’s diagnosis. He stated that it is imperative that patients be treated immediately, begin medication, and that their eyes are protected, as is Wynn’s.  Luckily it sounds like Wynn’s doctors are doing a fantastic job treating his condition.

Charlotte Bells Palsy Green Bay Packers Player Diagnosed with Bells Palsy

Bell’s Palsy Cannot Stop A Sack!

As a Charlotte area facial paralysis-Bells Palsy expert, I treat patients with facial paralysis.  Facial paralysis, or the loss of muscle tone on one half of the face, has significant functional, aesthetic, and emotional consequences.  To address this, there are many treatments to improve eating, breathing, eye protection, and symmetry of the face.  Improvement of the function and appearance of the face can have a profound impact on the patient’s psyche. Facial paralysis is a very complicated condition and should only be treated by an expert. Doctors who do not have extensive knowledge in facial paralysis can misdiagnose the cause of the paralysis, which may be detrimental to a patient.

The most common form of facial paralysis is Bell’s Palsy, which is caused by inflammation of the facial nerve.  This inflammation causes the nerve to swell and prevents the nerve from passing signals between the brain and the facial muscles.  The exact cause of the inflammation is not known, but most people believe it is from a virus.  The onset of Bell’s palsy is very abrupt and reaches its peak within 48 hours. Many patients report that their face suddenly feels stiff or pulled to one side.  The prognosis from Bell’s palsy is relatively good.  85% of patients suffering from Bell’s palsy will completely recover without any signs of facial asymmetry, 10% of patients will have an incomplete recovery with lingering facial weakness, and 5% of patients will have complete facial paralysis or significant synkinesis.

By training under one of the country’s premiere facial paralysis surgeons, I have a distinctive insight into facial nerve function and facial aesthetics, and have authored numerous book chapters on the subject. This knowledge provides my patients in Charlotte with customized facial paralysis treatment options.

 

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New Study Adds Information to the Treatment of Bell’s Palsy in Charlotte

Wednesday, June 6th, 2012

Bell’s Palsy is a sudden loss of function in half of the facial muscles.  It is believed to be secondary to inflammation, which causes swelling in the facial nerve.  Approximately 70% of patients diagnosed will have a complete recovery.

Facial Paralysis in Charlotte New Study Adds Information to the Treatment of Bell’s Palsy in Charlotte

Symptoms of a patient with facial paralysis or Bell's Palsy.

The chance of a full recovery is improved with prompt treatment within 72 hours.  Patients that do not completely recover have issues that range from mild to severe.   Patients with more severe issues may have complete paralysis of the hemi-face (that half of the face) or significant synkinesis.  Synkinesis is loss of the ability to independently make coordinated movements of the muscles of the face.  The face has 43 muscles that work in harmony to eat, blink, smile, talk, and show emotions.  Patients with synkinesis have difficulty with many of these functions.

Traditionally, patients with Bell’s Palsy that have been treated with high doses of steroids and antivirals soon after their appearance of symptoms had improved outcomes or chances of a complete recovery.   A new study revealed that patients treated with only the high dose of steroids improved their recovery and the antivirals had no effect.  This is an important study because it may give insight on the best treatment for patients with new onset of facial paralysis.

For my patients with Bell’s Palsy in Charlotte, I will still prescribe them high doses of steroids and antivirals regardless of the results of this study.  There are other studies that have shown that antivirals can be helpful in the recovery of the facial nerve, and they have a low side effect profile.  If there is a small chance that antivirals will be helpful for my patients with Bell’s Palsy, I will continue to use them.

This highlights the fact that while new studies and their results are important in the progression of best practices for taking care of patients, studies must be viewed in light of previous research and knowledge.  This is why patients cannot read an advertisement or news story that makes a claim about a new study and assume that it is the new standard of care.

I hope this raises awareness about the importance of seeing a doctor immediately after developing Bell’s Palsy in Charlotte to ensure the best chance of a complete recovery.

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Innovative Technique for Eye Support in Patients with Facial Paralysis

Wednesday, April 4th, 2012

I have a special interest and passion for treating patients diagnosed with facial paralysis. These patients normally have many functional, aesthetic, and emotional concerns.  During my training in Beverly Hills, I worked with a team of facial plastic, oculoplastic (eye plastic surgery specialist), and head and neck surgeons rehabilitating and reconstructing patients at the Facial Paralysis Institute.  During my training, in cooperation with two of my mentors, Dr. Babak Azizzadeh and Dr. Guy Massry, we developed anew minimally invasive technique to help support the lower lid, known as the MIOS procedure.

Patients that have facial paralysis lose all muscle tone in the face.  With the loss of the facial tone, there is a loss of support for the lower lid.  This can cause the lower lid to droop, possibly causing an aesthetic issue and also contributing to eye dryness. (Please see picture on link)

The new procedure uses two incisions, one hidden inside the eyelid and the other in the crease of the upper lid.  After releasing tissue that pulls the eyelid down, the eyelid is pulled up with a suture through the incision in the upper eyelid crease.  This works well on patients that have mild to moderate sagging of the lower lid.  It also has a lower complication rate when compared to other techniques.  I feel so fortunate to have worked and learned innovative techniques from the skilled surgeons in Beverly Hills, and I am glad to be able to offer them to the my patients in the Carolinas.

 

 

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Bell’s Palsy and George Clooney

Tuesday, March 6th, 2012

Why is half of my face paralyzed this morning?

Almost everyone has had a friend or a family member who woke up in the morning and suddenly could not move half of their face.  People typically notice facial paralysis while brushing their teeth.  This can be a frightening experience, but rest assured that most people will fully recover.

George Clooney Bells Palsy Bells Palsy and George Clooney

Can you tell who this is?   A young George Clooney, recovering from Bell’s palsy on his left side!

What are the typical symptoms of Bell’s palsy?

bells palsy symptoms Bells Palsy and George Clooney

What is the cause of sudden facial paralysis?  

The most common cause of sudden paralysis in the face is Bell’s palsy.  Bell’s palsy is a condition where the nerve that moves the muscles of the face becomes inflamed and swollen.  The swelling causes pressure on the nerve and prevents it from working.  There are many hypotheses for the causes of Bell’s palsy, but the most accepted cause is that it is a secondary result of a herpes simplex virus.

There are at least 20 other causes of facial paralysis that will be discussed in future blogs.  Bell’s palsy is only diagnosed if the doctor cannot identify another cause of sudden facial paralysis.  Some of the causes of facial paralysis may be serious, including cancer, so it is important that all patients with new facial paralysis be examined by a qualified physician, ENT, neurologist, or facial plastic surgeon that specializes in facial paralysis.

How common is Bell’s palsy?

Bell’s palsy is relatively uncommon, as it affects approximately 40,000 people in the United States per year.  Both men and women have an equal chance of having Bell’s palsy.  It is more rare in patients under 15 and more common in people older than 60.

If I am diagnosed with Bell’s palsy in Charlotte, how should I treat it?

Early treatment is imperative.  The doctor will likely prescribe two medications. Typically, patients are given steroids and an anti-viral medication.  The steroid is a strong anti-inflammatory that will help with the swelling around the nerve to speed up the recovery.  It is not the same type of steroid that athletes take to build muscle.  The anti-viral medication will help fight the possible virus that is causing the paralysis.  Pain medication can be taken if necessary.

The most important part of treatment is educating the patient about the possible risk to the eye.   When the face is paralyzed the eye may not be able to close.  This can cause the eye to dry out and this may cause a corneal ulceration, which may lead to vision loss and ultimately blindness.  All patients are required to keep the eye lubricated by placing eye drops and a thicker moisturizing gel on the eye at night.  Some doctors will recommend taping the eye closed at night to protect it.

What is the prognosis of Bell’s palsy?

The overall prognosis for Bell’s palsy is very good.  To discuss the prognosis, I place the patient into one of two categories:

1)      Patients that retain some movement in the face

2)      Patients that have total loss of movement in the face

 

Patients that still have some movement in the face have a chance of full recovery that is greater than 95%.  Patients that have lost all movement of the face have a 60%-70% chance of a full recovery.  An incomplete recovery means that the person has residual weakness of the facial muscles or the development of synkinesis.

When will a patient begin to see recovery from Bell’s palsy?

Patients will begin to see a recovery in 2-3 weeks and generally experience full recovery in 3-6 months.  The nerve will continue to improve over the next full year.

What is synkinesis?

Synkinesis is loss of coordinated movement of the face.  When the nerve recovers, it has lost the ability to precisely move muscles.  When patients try to smile, it may cause their eye to narrow or the muscles in the neck to contract.  There are many different presentations of synkinesis.

Is synkinesis treatable?

Yes!  It is treated with Botox or Botox-like medications.  This will be fully discussed in future blogs.

Why is a facial plastic and reconstructive surgeon in Charlotte talking about Bell’s palsy?

I have special interest and training in facial nerve disorders including facial paralysis, facial weakness, and facial synkinesis.  There are many treatment options, both non-surgical and surgical, to improve the function and appearances of patients with these issues.

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