Patients who have experienced Bell’s palsy or partial improvement in their facial paralysis can develop synkinesis. This problem does not always occur, but when present, it can be mild to severe. Physical therapy and targeted Botox® injections are still the preferred option in the treatment of synkinesis. However, in some instances, synkinesis may persist despite prolonged treatment.
In these cases, surgery may help disrupt the divergent neural pathways that are responsible.
Dr. Panossian has extensive experience in the treatment of this condition and has developed a unique surgical strategy. He works closely with facial rehabilitation therapists to coordinate treatment for those who continue to struggle with synkinesis.
Targeted Nerve Destruction (Neurolysis)
Surgery to treat synkinesis requires understanding the aberrant pathways of stimulation that occur in a person recovering from facial paralysis or Bell’s palsy. Through initial treatments using selective Botox® injections, these pathways can be better elucidated. Targeted nerve destruction, or neurolysis, can then be performed with greater accuracy. This involves identifying the nerve branches that are the culprit through a facelift approach. Nerve monitors are used to very carefully identify tiny branches in the area of interest. They are then stimulated to verify the targeted pathway before dividing them.
Targeted Muscle Destruction (Myectomy)
As an adjunct to neurolysis, targeted muscle release or destruction can be performed to diminish unwanted twitching or contraction. This involves identification of the overactive muscles prior to surgery and possibly targeting them initially with Botox® injections. For example, muscles such as the lower lip depressors and the platysma (broad muscle extending from the jawline down into the neck) can be weakened to reduce their downward force on the lower lip. Accessory muscles responsible for nasal twitching can similarly be weakened surgically to prevent troublesome contractions.
Other techniques are currently being explored for their usefulness in synkinesis. Cross-face nerve grafts and nerve transfers are possible options that may help deliver “clean” stimulation to areas of synkinesis. Dr. Panossian is an expert in the treatment of synkinesis. Call today for a consultation, if you are experiencing synkinesis or residual facial paralysis.
Why choose Dr Panossian
- He received his medical education at Tufts University School of Medicine.
- Graduated at the top of his class at UCLA, receiving Phi Beta Kappa and Summa Cum Laude honors.
- Was accepted into an elite combined general surgery and plastic surgery residency at the Keck School of Medicine of USC.
- Completed subspecialty training in craniofacial surgery at the Hospital for Sick Children in Toronto and Harvard Medical School.
- Was mentored by Dr. Ron Zuker in the practice of facial paralysis reconstruction. This prestigious fellowship position was available to only one surgeon in the United States.
- Is affiliated with various charitable and educational organizations, including Operation Smile and Mending Kids.
- Is a member of the American Society of Plastic Surgeons and the highly selective American Association of Plastic Surgeons, reserved for only a select group of individuals nationally who have demonstrated excellence in academic plastic surgery.
- Holds memberships in several other professional societies including the American College of Surgeons and the American Society of Reconstructive Microsurgery.
- He serves on the Board of Directors for Mending Kids and the Gondobay Manga Foundation, a non-profit organization dedicated to the improvement of lives in Sierra Leone.
- Has been nominated by his peers annually since 2012 as a “Super Doctor.”
- Served as an expert medical consultant and appeared on The Doctors, Grey’s Anatomy, and Nip/Tuck.
- Has been featured as “Top Doctor” in US News and World Report, Pasadena Magazine, and Los Angeles Magazine.
Last modified by Dr. Andre Panossian
