Q. One of my friends had Bell’s palsy several years ago. She is doing well but continues to have facial movement asymmetry. She’s very self-conscious and does not want to go out. Is there anything I can tell her that you can do for her?
A. Bell’s palsy is a weakness or paralysis of the facial nerve. This is a diagnosis of exclusion; therefore a doctor must rule out a tumor affecting the facial nerve. The disability may range from mild asymmetry to near complete facial paralysis on one side.
A lot of things that can be done for patients who have Bell’s palsy. The idea is to make the face look more symmetrical. One would think treating the side that has little to no movement is the correct method, but it is not. Treating the normal side to subdue movement will make that side look like the abnormal side and therefore more symmetric. Botox or Dysport are used to weaken the normal muscles so that symmetry is achieved when the patient is smiling or making facial movements. In addition, because the muscles are no longer active, facial volume may be lost and lip asymmetry may be noted as well. Facial volume can be restored with facial fillers including Restylane, Juvederm, Radiesse, Sculptra and Bellotero. Lip size and asymmetry can be corrected with some of these fillers as well. Very often this treatment is a treatment of trial and error as trying to get absolute symmetry is difficult. Keeping careful records and diagrams helps to do this. Patients can enjoy a very normal life while feeling less self-conscious as their facial movements are more symmetric. Tell your friend she should find a facial plastic surgeon, plastic surgeon or dermatologist who understands facial movement and anatomy.
Dr. Carlos Wolf is a partner in Miami Plastic Surgery and is board certified. Email your questions to him at Cwolf@miamiplasticsurgery.com.