Q: I had Bell's palsy and my face is now asymmetrical. It seems to be more noticeable as I get older. What are my options? I really don't want surgery.
A: There are many options that were not available years ago. I'll discuss only the nonsurgical options in this column.
For those who don't know, Bell's palsy is a facial paralysis of sudden onset that might be one or two sided. Bell's palsy is a diagnosis of exclusion. In other words, your doctor must determine no other cause for the paralysis, i.e. tumor, stroke or infectious agent. Fortunately, most Bell's palsies resolve on their own. Some patients will get better but still have facial asymmetry with movement, which is what you may have. For this, Botox injections are successful. (And you thought Botox was only for pretty cosmetic uses.)
I generally inject patients in their normal side to decrease the amount of movement so that the abnormal side will look symmetric. In addition to improving the movement disorder associated with Bell's palsy, I inject patients with Restylane, Perlane, Juvederm, Sculptra or Radiesse. I use any one of these products alone or in a combination to fill contour defects and loss of volume defects. If you go this route I suggest you find an expert Botox injector who has experience in injection techniques throughout the face and is well versed in the anatomy of the muscles of the face. Good luck.
