Bell’s palsy can cause sudden changes in facial movement and symmetry. While many patients recover over time, others experience lingering effects that impact comfort and confidence. In these situations, injectable treatments may play a role in improving facial balance. In this blog, Dr. Lisa Ishii covers what patients considering neuromodulators like Jeuveau, Dysport, and Botox for Bell’s Palsy should know.
What Is Bell’s Palsy?
Bell’s Palsy is a type of facial neuropathy, in which the facial nerve (cranial nerve VII) becomes inflamed, causing sudden onset facial drooping and asymmetry. Anyone can be affected by Bell’s Palsy, although autoimmune disease or viral infections may increase that risk. Most commonly, it presents as unilateral facial weakness with difficulty closing the eye and crooked smile. It can also affect tear production and even can affect taste sensation changes.
Facial Imbalance After Bell’s Palsy
Bell’s Palsy affects the facial nerve (cranial nerve VII), which causes a variety of facial asymmetry and other related symptoms. Most commonly, the symptoms are unilateral. The patient will have difficulty raising the eyebrow and closing the eye on the affected side. The smile will be blunted and asymmetric on the affected side, with flattening of the nasolabial fold. Other symptoms may include sensitivity to sound and decreased tear production. Rarely, bilateral Bell’s Palsy is possible.
What Treatment Looks Like
The first line treatment for Bell’s Palsy is always medical management. Depending on the suspected etiology, your primary care provider may prescribe an oral steroid or antiviral therapy. Typically, the facial asymmetry from the Bell’s Palsy will resolve in 2-3 months.
In about 30% of cases, patients may have unresolved facial asymmetry even after the 3-month period. These patients are candidates for treatment with neuromodulator to help camouflage the residual asymmetry.
Neuromodulators Like Jeuveau or Botox for Bell’s Palsy
Neuromodulators are medicines that can be injected into facial muscles to prevent the muscle and nerve from communicating with each other. The result is a relaxed muscle that cannot contract quite as robustly. Cosmetically, this is often done to relax the “11” lines between the eyebrows or the Crow’s Feet wrinkles. In the case of Bell’s Palsy, neuromodulators can be used to target certain muscle groups to help camouflage a crooked smile or asymmetric brows and eyes. While counterintuitive, typically the side that was not affected by the Bell’s Palsy is targeted to purposefully relax those muscles to better match the permanently affected side.
Expertise Matters: Provider Selection
Neuromodulator treatment for Bell’s Palsy takes skill and an expert knowledge of facial anatomy. Oftentimes, the muscles targeted are not “classic” muscles targeted in routine aesthetic neuromodulator treatments, and therefore a “cookie-cutter” approach is insufficient for optimal results. Dosing is also variable, as different muscle groups are affected variably in different individuals. Functionality is also key: especially as normally functioning muscle groups are oftentimes the target for treatment, conservative doses must be used to ensure that proper function is maintained.
Setting Realistic Expectations
Like with any aesthetic treatment, perfect symmetry is impossible! After all, the two sides of our faces are sisters, not twins! Even with optimal dosing and placement of the neuromodulator, some residual asymmetry is to be expected. Occasionally, a few follow up sessions are needed to perfect the dose. Like with any neuromodulator treatment, maintenance is required every 3-4 months.
Neuromodulators are not a cure for Bell’s palsy, but in carefully selected patients it can be a valuable tool for improving facial balance, comfort, and confidence. If you are in the Raleigh, Durham, Chapel Hill area and looking for an injector experienced with treating Bell’s Palsy, contact our office for more information.
