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Bell’s Palsy Live Q&A Recording: October 2022

During our Live Q&A session in October this year, we answered over 30 questions regarding Bell’s palsy and synkinesis recovery, as well as other questions related to peripheral facial palsy and its complications.

At Crystal Touch Clinic, our mission to help Bell’s palsy sufferer to achieve maximum recovery. Not everyone is able to come to our clinic and follow the rehabilitation program online. For those of you, we try to share as much valuable knowledge as possible, and answer your questions.

Below is the recording of the Q&A session from October 21 2022. You can listen to Alex’s answers in the video, or read his replies to the questions under the video. There is a total of 33 questions that were answered regarding facial palsy, Bell’s palsy, synkinesis, facial pains, and other issues experienced.

If you could not find the answers to the questions that bother you, or if you would like to receive a more detailed analysis of your current condition, you can reach out to us or register for a remote diagnostic session (ZOOM video call).

The Recording of Bell’s palsy Q&A

You can navigate to different question in the video by clicking the corresponding circle in the video’s timeline.

List of questions

Below you will find all the questions and answers in the written form. You can also use the number links below to skip to the specific question on this page.

Estimated reading time (all questions): 33 minutes

1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 10.1 | 10.2 | 10.3 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33

1. Can you please tell us if Acupuncture would be helpful for residual synkinesis, i.e. facial relaxation and recovery?

In general, acupuncture is a great tool, that has survived for thousands of year. I have a very big respect or it. It can provide help and ailment for many issues with our bodies.

In particular for synkinesis, acupuncture, in my opinion, will not render a lot of help. Except for the help with relaxation of facial muscles. Some of our patients, who followed acupuncture, do say that it helps them to temporarily relax their facial muscles. When your face is relaxed, synkinesis can become less pronounced.

So it can have an indirect effect on synkinesis, but to our knowledge, there is no direct influence from acupuncture on synkinesis.

2. I suffer from Bell’s palsy for 42 years. Is there any remedy for this? I still can’t close tightly my right eye, and I suffer from teary eyes.

The majority of medical world has an opinion that synkinesis are caused by aberrant regeneration. Based on that theory, there is not much that can be done to improve one’s condition after facial palsy.

In our clinic, we have a different point of view. We do not think the cause of synkinesis is aberrant regeneration. Our rehabilitation approach is based on the idea that synkinesis occur as a result of changed mimetic habits. These habits can be changed, and so, synkinesis and other complications can be reduced, even after 42 years or more.

We had one patient, who came to us with 62 years since her Bell’s palsy onset. She had facial palsy when she was 2 and a half years old, and she came to the clinic after she turned 65. She was able to achieve improvements, and her portrait is hanging on our “Wall of Honor” in the clinic.

Teary eye can also be addressed and worked on during the rehabilitation process. It is not magic, it will not happen overnight, but the absolute majority of our patients who experienced teary eye, also known as Crocodile Tears, achieved improvements and were pretty satisfied with their results.

3. My eye is getting smaller on the affected side. Is it possible to prevent it somehow and how to make it bigger again, if possible.

Your eye is getting smaller because the circular muscle of the eye, the muscle that surrounds the eyeball and occupies the eye socket, is getting a lot of background signals from the brain – tonal signals.

Due to those tonal signals, your eye muscle experiences certain background contraction all the time. That is why your eye fissure becomes more narrow and your eye looks smaller.

Our opinion in the clinic is that after a long facial palsy recovery, your brain learns to keep “pushing” the muscles as hard as possible, to produce facial movements. This attitude remains even when you are not producing any expressions. So when your facial muscles constantly experience elevated tension, your eye fissure becomes more narrow, for some patients the nasolabial fold looks deeper, and dimples appear on the chin.

Those are all symptoms of increased intensity of background contracture signals that are created in the brain, and they are sent all the time, almost constantly, towards the facial muscles.

That is why you experience extra tension of the face during the day. This can be alleviated with a proper rehabilitation program, that will teach your brain to stop sending those background contraction signals constantly.

Recommended article: “Why is my face so stiff and tired after Bell’s palsy?

4. Is it okay to use fillers into the nasolabial folds to hide a contracture (to make the face look more symmetrical)? If yes, what filler is more secure with this condition?

[The question was asked by Katya]. Katya, you are still young, 25-26 years old, as I remember. To use fillers at your very young age, I think it is a little too early.

The filler may cosmetically fill in the nasolabial fold, but it will not help with it in the long-term. That nasolabial fold is created by the excessive tension of the muscles, which will not go away if you use a filler.

Fillers are not permanent, so the result will be temporary. The filler will dissolve, and you will have the same initial situation as you had it before.

Unless you address the core cause of that particular symptom that you are trying to improve, it will be just there all the time.

5. What do you think about the upper blepharoplasty surgery to make the eyelids look more identical? I am afraid that it might be harder to close the eye or blink after it.

[The question was asked by Katya]. Again, at your very young and strong age, it is not appropriate, in my opinion, to go for blepharoplasty.

Because the smaller eye fissure is not due to some organic reasons which have to be corrected by surgical intervention. It is simply due to the reason that your circular muscle of the eye – musculus orbicualris oculi – receives additional contraction signals from the brain.

As soon as you will start learning to maintain the background relaxation of your facial muscles, we have all reasons to believe that this problem will become less urgent, and you will not be as eager to fix it with a surgery.

We need to realize that whenever a surgeon’s knife enters your body, that is one way. Whatever the result may be, good or bad, with or without side effects, it is a one way street. You cannot undo it.

Recommended article: “Surgical Interventions for Bell’s palsy

6. After 11 months since my Bell’s palsy I started seeing a chiropractor who was working on my neck. Initially, I saw many improvements, but after a year I stopped seeing changes. Now my face is very tight and I have synkinesis. Did I make a correct choice by going to a chiropractor? Is there anything else I can do here in US to improve my condition?

If your chiropractor knows what he or she is doing, it can be good to attend those sessions. It is good for your general health, for the mobility of your joints. It can also be helpful for background or basic relaxation of your body and your face in particular. So I do not think you did anything wrong.

Synkinesis is a symptom that will develop in most of the cases, if the recovery after facial palsy follows a longer recovery scenario. It is a recovery scenario where the damage to the facial nerve was deeper. In this case, the degeneration of nerve fibres will take place. Regeneration of nerve fibres is a slow process, and can take anywhere from 5 to 10 weeks, or even longer, until the first movements may appear.

In these cases, a certain degree of residuals and complications in a form of synkinesis or increased background contraction level of the facial muscles, is difficult to avoid. So I do not think that you should be regretting your visits to a chiropractor.

It is possible to work on it later on, and reduce the manifestation of synkinesis and other complications. We work on that in our clinic. We are the only clinic that performs this particular rehabilitation method – Neuro-Proprioceptive facial Rehabilitation.

In the US there are other specialists, but as far as I know, most of them suggest either surgical intervention – like Facial Paralysis Institute in California – or they use in one or the other way injections of Botox. What is better for you, that is up to you to decide.

7. I have had Bell’s palsy for over a year now and have some lasting damage to my eye and mouth. I saw some improvements after your last Q&A session, when you advised to do regular massages. I continue doing them. My neurologist suggested that I do Botox. What is your thought on that?

Botox is the modality, this is recommended by most of the specialists after it has been established that synkinesis and contractures or increased excessive level of muscle tension has developed.

We need to realize that Botox is a commercial name of Botulinum Toxin, which is essentially a poison. In its action, it blocks the transmission of the contracture signals from the nerve to the muscle.

A place where a nerve fibre ends, and a muscle fiber starts, is called a neuromuscular junction. Botulinum toxin blocks this junction, and the nerve cannot transmit the signals to the muscle.

It is an irreversible situation. That part of the nerve ending dies. So the nerve fiber starts to grow a side terminal to reconnect to the muscle that is deprived of signals coming from the brain.

That is why the effect of botulinum toxin injection is temporary. It takes from 2.5 to 4.5-5 months before the effect of botulinum toxin disappears.

It does provide certain symptomatic relief, but it is not permanent. In our clinic, we do not use it and do not recommend it to our patients. Because our approach is to work on the underlying cause, instead of focusing on just reducing the symptoms temporarily.

8. Also, my balance has never returned and use a walker all the time because I am afraid of falling. I also lost hearing on the affected side a few months after the onset. None of the Doctors I have seen seem to know what to do for me. I am 77.

I realize that you are a very grown-up person, you are 77 years old. So, of course, regenerative capacity of your body is lower. Considering that your balance was disturbed, and you lost the hearing, indirectly I can conclude that the inflammation in this area, in the initial part of the onset, was pretty severe. Most likely, it was caused by a viral infection in the form of herpes virus.

In a lot of cases, when herpetic infection is there, a patient may experience painful sensations, that can vary from moderate to high. It is an indication that the effect of that inflammation, caused by viral infection, is very heavy.

If that infection is extensive, then also our hearing device – cochlea – can be affected. Otherwise, the hearing nerve can also be involved in the process of infection and inflammation. The hearing nerve, which runs pretty close to the facial nerve, provides signaling to our balance sensation and to our hearing. During a heavy inflammation, it may become damaged as well. In these cases, hearing and balance can be disturbed or disrupted.

I would need to know more details of your history and current condition to be able to provide more details and explain why you might be experiencing this. We can do that during a video call and consultation.

9. What must I do if I see no improvements for almost a year now? I have synkinesis, some tight muscles, as well as my cheek still looks a bit swollen.

You say, “I see no improvements”. Probably it is not entirely correct. Because in the acute phase you had no movements at all: your eye was wide open, nothing would move. Now it is exactly the opposite. Now your affected side is much tighter than your healthy side. That is why you also have synkinesis and tightness of your facial muscles. It happens for the same reasons as explained in questions 4 and 6.

Your cheek looks a bit more swollen than on the healthy side. It is probably because your muscles are not contracting and relaxing as intensely as the muscles on the affected side. As you probably know, our lymphatic system, has no engine. The blood vessels have their engine – our heart, but the lymphatic system does not. The only way to propel the liquid through the lymphatic vessels, is contractions and relaxations of the muscles. When we sit for long time in the plane, for example, in the train or in the car, then we step out – our legs could be swollen. Because our muscles do not contract and relax, so they do not propel liquids through the lymphatic system. That could be the reason why your cheek appears swollen.

Do not hesitate to touch your face with your hands. Do a gentle face massage with your hands, or ask someone to do it for you. The massage should always be symmetrical: from the mid-line – outward, and from the lower part – upward. You can also do it also with your fingertips, gently working with circular movements on your muscles one by one.

10. I had Bell’s palsy since December 2021. I didn’t recover fully. I have facial tightness and uncoordinated facial expressions. I still have numbness, mild pain and ringing in my ears. I have been doing daily facial massage, but stopped exercising because I heard that was bad for the tightness and could make the muscle tightening worse. In my area the doctors only advise exercising, physical therapy, acupuncture, etc, but it all does nothing.

You refer to uncoordinated facial expressions. Indeed, on the later stages of a longer recovery, the coordination – reciprocal inhibition between agonist and antagonist muscles – becomes disrupted. This leads to massive contractions of muscles at the same time.

Normally, when everything is working properly, both in our facial and body muscles, when the agonist muscle contracts, the antagonist will relax. For example, if I contract my bicep, the tricep will relax to allow for this. If the tricep would not relax when I contract my bicep, my arm would remain straight, as antagonist would suppress the movement of the agonist. In addition, if I kept trying to force the bicep to contract, other muscles in the area would also contract, and my whole arm would become very tense, but it would still not fold.

The same happens with our face. During the long recovery period, the mimetic patterns of the face will change because for a long time the brain could not manage, or could not move your facial muscles in an expected manner.

To discuss this question further, we would need to schedule a detailed diagnostic session, so we can over each detail for your specific case. There can be different reasons why one or the other thing happens. To answer without speculation what it can mean in your case, I need to know more details of your recovery history and current condition.

10.1 Will the ringing in my ears ever stop?

The ringing in the ear is related to a very tiny muscle. It is about 3 mm long. The smallest muscle in our body – musculus stapedius. It makes part of our hearing organ.

When that muscle is contracted, or super, extensively relaxed, then the eardrum is either very tight or very loose. The ringing that you “hear”, is not actually a sound, there is nothing producing it. The constant deformation of the eardrum creates a sort of “parasitic” signals, that you perceive as ringing.

Sometimes, a patient may develop this kind of synkinesis. When he or she blinks the eyes or puckers the lip, you hear a clicking sound in your ear. It is also because due to the same mechanism as other synkinesis, this muscle contracts a little bit and creates a feeling of non-existent sound.

If this is the case, then we can work on reducing this synkinesis during a rehabilitation program.

10.2 Will my face straighten out over time on its own?

It is not likely that it will straighten out on its own. Because it is a habit.

For example, take handwriting. If you do not work on your handwriting, your handwriting will is likely to remain exactly the same until the rest of your life. So when you write a letter to your family who knows you, they will recognize that it is from you, not even having to look at the signature. Because the handwriting is a habit that your brain has developed when you were learning to write at school, and later on in the course of your years it has formed into a constant handwriting.

So, on its own, it is not likely to change. You need to work to change your subconscious habit.

We have achieved that successfully with many patients, also those who came to us after 10, 15, 20 or more years since their onset. We do not perform miracles, we work together with our patients. It is always a cooperation of efforts. We have been able to achieve improvements with the absolute majority of those. There are a few who have not, but those were mostly due to specific features of their psycho-emotional structure, and their attitudes towards themselves and towards their rehabilitation process. So you need to be prepared to work and invest some time and efforts to make it happen.

10.3 Is there any bona fide therapy that does work to help cure these residual symptoms?

I would say that the word “cure” here is not really applicable. Because you are not sick. You are dealing with complications. The same, like limping after a broken bone of a leg, for example. It is a result, a consequence – complications and residual effects that developed during the long recovery process after your facial palsy. To reduce them, you need to follow a rehabilitation program.

Bona fide therapy – I wouldn’t say that our therapy is bona fide, but this is what we do. You can learn more about our method, as well as the method of other practitioners, and decide for yourself, what is better in your case, for you.

11. Is it possible to have my smile back after 3 years of Bell’s palsy?

Please, realize that you do not have Bell’s palsy anymore. Bell’s palsy finished when the first movements started to return.

Palsy is paralysis. You do not have the paralysis, anymore. You have residuals and complications in the form of synkinesis, hyper-tone and probably others, maybe some painful sensations as well. You might have some tender, painful spots above the eyebrow, around the cheekbone, at the edge of the lower jaw, and so on. These are symptoms of complications.

Yes, it is possible to work on returning your smile. It does not matter if it has been 3, 5 or 20 years since your Bell’s palsy onset. The level of improvements you can achieve depends on the initial damage to the facial nerve, your current recovery, as well as your patience and hard work during the rehabilitation process.

It is not a miracle, and it will not happen overnight. I realize that in absolute majority, Bell’s palsy happens overnight. So subjectively, you may think that since it happened quickly, it also should come back quickly. Like switch off and on the light.

Unfortunately, it is not that easy. Facial palsy is an injury that your body sustained. If somebody breaks a leg, you do not expect that person to run around and play football the next day. Because the body needs time to consolidate the bone, recover its condition, retrain the muscles back into the normally functioning condition, and so on. It is a process. To recover further, you need guidance and help. We are able to provide that and help you on your journey to bringing back your smile. Speak with us.

12. I recently saw a documentary on some new research conducted by the John Hopkins University in the USA regarding Psychedelic therapy in the treatment of a multitude of problems such as alcoholism, depression, PTSD, and brain related damage and deterioration. The research discovered that this new therapy actually regrows the branches of the brain that have been damaged and disconnected from each other. Do you think that this therapy could in the future be useful in the retraining of the brain in relation to recovery from long term Bell’s palsy synkinesis?

During Bell’s palsy – or a more correct name of the disorder would be peripheral facial paralysis – there is no brain damage. What becomes damaged is just one nerve of the whole body – the facial nerve. It is a peripheral nerve. The brain is the central nervous system.

During Bell’s palsy, the brain remains intact. The fact that it develops different management of muscle is, again, not due to brain damage. For example, if your pen wights 2kg, you can still write. If you will be writing with this pen for 3 years, your handwriting will change. Then, when you take a normal pen again, your handwriting will not be the same as before with the same pen. Because your brain has developed a new manner of moving your hand and your fingers based on the weight of the tool that you were using to write.

That is why I think that that particular method could be very helpful for patients with alcoholism, depression, PTSD and so on. As for fighting synkinesis, my opinion – I’m not an expert in this field – applications to the facial palsy is not likely to be extremely efficient. Time will tell whether it will work, yes or no.

13. After having Bell’s palsy for many years, what is the procedure to get back some movement?

This is a rather general question. It is difficult from this short description to tell exactly whether you have no movements, or you experience the residuals and complications. Which are synkinesis, tightness of facial muscles, and so on.

So if you have no movement, it is a different story, than if you have synkinesis or tightness. Unfortunately, I cannot answer this question without more information.

14. Why does my affected side react to cold weather so severely? What can I do to help the ache?

It is quite common when the patient, after a long-standing, non-fully recovered facial palsy, is very sensitive to cold. It is partly due to the quality of the facial nerve fibres.

Here is my speculation. The brain reacts over intensely to anything that happens to the affected side. Whether it is facial movements or reflexive contraction of the muscles in response to cold, the brain tends to over-amplify anything that has to do with facial movements or contraction of the facial muscles. Also, it relaxes and releases the tension much less eagerly.

What you can do to help. Touch your face, do gentle massages. Massage movements should give you calmness, relaxation, be pleasant and restore to certain extent, the feeling of unity in your affected and healthy side, to reinstate your feeling of oneness of your face.

15. I’m suffering for 36 years, can I get relief with your therapy? What can I do?

If your recovery pattern is what similar to those described in questions above, more or less follows a regular pattern of recovery: synkinesis, tightness, pains, etc. Then yes, from my point of view, it is possible to improve.

What can you do? The best thing to do is to make contact with us. The best way in order for us to get a better understanding of your situation is to register for an online diagnostic video session. We can take a look together with you, discuss your questions and I can assess also your facial condition and let you know what recovery progress it is possible to achieve if you work with us.

16. ​I have bell’s palsy for 2.5 years and there are very strong residual effects. There is no recovery dynamics at all right now. Is there any hope for recovery according to your method?

After approximately one year, the development of residuals and complications reaches a kind of equilibrium, balance. After approximately 9 – 13 months, the facial condition reaches saturation point, and it is not likely to change – become either better or worse – for a long period of time, if you just leave it be on its own.

Because as I said, it is a habit. The brain has reached a certain balance in moving your face, to compromise for incompletely recovered nerve fibres.

If you leave it like this, it is not likely to change on its own. The brain will solidify its movement patterns, and it will remain like this.

Fortunately, if you do decide to work on improving your condition, absolutely, there is hope and expectation for improvement of your condition. I do not want to promise you 100% recovery, which something that practically every patient is dreaming of. Theoretically, it is possible to achieve 100% recovery, but it takes disproportionate amount of time, effort and resources. Of course, nobody is prepared for that.

Still, achieving improvements – it is absolutely possible, provided that you are prepared to work and that you are committed. Then, we can work together for as long as you will see it necessary and until you are satisfied with your results, and you can regain your quality of life.

17. Is there anyone in Canada offering your method of treatment?

Unfortunately, no. We are in the Netherlands, and we do not have branches or partners who practice our method. If you would like to join a rehabilitation program with us, feel free to contact us, and we will see how we can work together.

18. How can synkinesis be improved?

To reduce synkinesis it requires at least several months, close to a year to achieve improvements.

As I mentioned, it is a habit. Changing any habit that has been formed, requires time, persistence, perseverance, regularity, commitment, etc.

Synkinesis can be improved by changing the dominant focus of attention of your brain. At this moment, your brain is used to amplify signals going to your affected side. Instead of telling them “Go.”, your brain is shouting “Go! Go! Push! Push!”. We need to change that, as it is exactly the opposite of what we need.

The harder your brain pushes, the more muscles become involved and the more unrelated facial muscle contractions you will have. What exactly is the process of changing this habit, is a very complex and long explanation which I cannot answer in this short Q&A session.

19. What is your suggestion for people like me who have had Bell’s palsy for over 4 years? Do we have hope in having some type of normal face?

I understand your frustration about the case and as I said, absolutely, yes, it is possible to improve your face. It also depends on what you mean by “normal” face. If you refer to your face as it used to be 4 years ago, then it is not likely to happen.

You are 4 years further in your life. Your body is 4 years different from what it used to be 4 years ago. Even without facial palsy, your face would look different now, than it used to be 4 years ago.

“Suggestion for people like me who have had Bell’s palsy for over 4 years”. General suggestion is – do not force your face into facial expressions. In most of the cases it is not the matter of power of your facial muscles. It is rather a mater of balance in their activation, contraction and relaxation. That comes from the brain. Try to refrain from making hard facial movements, like making faces in front of the mirror. That is our approach in the clinic. We have a justified opinion that this can lead to increase in the level of unwanted contractions of your facial muscles.

Spend some time every day, listening to your face, trying to relax consciously your face: one by one, muscle by muscle, going down from frontal muscle, going to the eye muscle, mid-face muscle, muscles around the mouth, ad neck muscles, and so on. It is important to do this everyday, so you can build up progress over time. Spend a few minutes every day, 5-10 minutes, maybe. Then, little by little, you will probably notice that your general tension of your face will reduce.

Also do self-massage, touch with your own hands your face. Your hands are the best rehabilitation instrument that will ever be invented. That our opinion in the clinic. Do not hesitate to touch your face, to explore it, to listen to it.

20. ​I had Bell’s palsy in April. I started feeling better in May, but then started having problems again: that side feels tense, and when I smile, the inner corner of my eye moves. It bothers me so much. Is it synkinesis?

It has been 6 months now, since April. It is, indeed, the regular time frame for formation of complications after facial palsy.

So if your question is whether it is synkinesis, it is not only synkinesis, but probably also the increased tone of your facial muscles and certain disruption in the balance of contraction and relaxation of your facial muscles during facial movements.

21. Is there any exercise or massage to reduce Crocodile Tears that I can do myself? 1.5 years of Ramsay Hunt Syndrome.

We do not have a specific exercise that is only aimed at reducing Crocodile Tears. We do know, that our patients during their rehabilitation program in the clinic or online, experience reduction of Crocodile Tears. So it is, yes, possible to reduce them, but it is not a simple exercise that can be done in isolation without a rehabilitation program.

22. Can synkinesis be reversed after having it for 5 years?

The answer is “yes”. To let synkinesis disappear completely is a very challenging task. It is the same as to change your handwriting completely and to make it automatically totally different than you used to have.

Intensity of synkinesis can be reduced. In a lot of cases can be reduced substantially. There are several factors that can influence the intensity of reduction. In general, the answer is – yes, it is possible.

23. ​I also have synkinesis. Bell’s palsy started on the left side of the face in mid-January, and now about 80% recovered (after 9 months). My synkinesis is my left eye tears up when I eat. Any recommendation on how to fix?

What you are describing is Crocodile Tears – when you eat, your eye tears up. There is an explanation for this, from my point of view.

In the inner corner of the eye, there is a little tear sack, where tears, produced by the tear gland, are stored. So the tears are being produced and collected in that little tear sack.

The tear sack is closed by a little round muscle – sphincter. This muscle is also innervated by the facial nerve. When you eat, when you move your muscles around your mouth, in a kind of synkinetic motion, this little muscle starts to open and close uncontrollable. By this, it releases a disproportionate amount of tears from the tear sack and your eye waters. This is my speculation.

Recommendation, “how to fix”? The general recommendation applies here as well – try not to force your face. Try to practice relaxation. When you eat, try to do it without forceful movements of your face. Try to just keep it the way it happens, without putting extra pressure. Any forceful movements may exaggerate the involuntary contractions of other facial muscles.

24. My eye also tears when I eat. I drool at night if I sleep on my affected side. What can I do?

The answer about the tears can be found in the question above. As for the drooling, it is difficult to tell why it might be happening without knowing how long has passed since the onset of your facial palsy.

Drooling can happen for various reasons. Sometimes children also drool when they sleep, it does not mean that there is any pathology. Maybe your affected side relaxes when you sleep more. When you dream, maybe your affected side experiences a higher level of relaxation, or a lower level of background tension, which is called tone. Even a person without facial palsy may be drooling at night.

If you were to speak with us directly, I could have a better insight in your particular situation, see your face in movement, see your pictures, have your history in more details. Then I could say in more detail if your drooling is a result of facial palsy, and if yes, what we can do about it and other symptoms that you experience.

25. Is mime therapy or neuromuscular retraining helpful for synkinesis and for the control of the unwanted contractions of the muscles, especially the eye muscles? Are there other treatments or methods that help with synkinesis?

I find it a bit difficult to give evaluation of the methods that other specialists are offering to the facial palsy patients. I have no doubt that those who are practicing Mime Therapy for the patients, or the Neuromuscular Retraining, have absolutely the intention to help their patients.

What I can tell is that in our approach, we do not use elements of Mime Therapy or Facial Gymnastics, as it is sometimes called in some countries. We do not do that because we think that forceful movements of the face are not helping to overcome synkinesis.

As far as I know, Neuromuscular Retraining, in some cases – I am not informed of it in detail – involves injections of Botox before the person starts doing exercises. We do not use Botox, as you know from previous questions. We do not use it for a simple reason that it is a symptomatic measure, symptomatic modality that does not address the core underlying issue that patient is having.

Of course, it is up to each patient to evaluate whether what we, or others are doing, is helping them, based on their own results.

26. In synkinesis is the nerve damaged?

No. Synkinesis is a result of new mimetic habits, in our perception and understanding of the issue.

At the beginning out all the rehabilitation programs in the clinic, we always perform nerve conduction study and synkinetic correlation test to evaluate and record, objectively, the level of nerve recovery and synkinesis. These are two instrumental methods that we use. We elaborated the former to encompass an extended protocol, and developed the latter from scratch, so we can measure objectively the recovery of facial nerve and synkinesis.

So, in the vast majority of cases, we see that the level of recovery of the nerve is very high. It is usually around 75-80%, and still the person has synkinesis.

That is an indirect confirmation that synkinesis do not depend that much on the percentage of recovery of the nerve.

Actually, synkinesis only start to manifest themselves more or less after 50% of the nerve capacity has been restored. This is our observation.

27. If I get pregnant, how can I avoid additional paralysis (I have the problem on the left side from December 2021, 38 y.o.)

I do not think that pregnancy, by itself, can exacerbate or can make your symptoms heavier. Pregnancy by itself is a great thing, you bring new life to this Earth. I do not think that you run risk of additional paralysis.

Indeed, pregnant women in the last weeks of their pregnancy are a risk group for facial palsy. It does not mean that every time somebody gets pregnant, she will get a facial paralysis. Relapse of facial palsy happens very seldom, and can happen due to a variety of reasons.

If you and your partner decide to have a child, and you believe that you have a predisposition for a relapse of facial palsy, then you simply have to decide if that is something you can sacrifice in order to have a child.

Again, the possibility of a relapse, without known predispositions, is extremely seldom. If you would like, we can speak about it in more detail during a video call.

28. My concern is in relieving contractures that have appeared 4 months after Bell’s palsy onset. What can I do?

“Contracture”, is not exactly, from my point of view, a correct name for what you are describing. “Hypertension” – yes. “Contracture” in medical term is something different: it is a change in muscle structure that leads to irreversible changes in the function of that particular muscle.

From our observation, it is not the case. So what you experience is a higher background tension, which is tone.

Again, to try to reduce it by yourself, listen to your face. Do not do it hastily. Do not do it when you sit and watch television. Reserve special time for it. Leave your mobile phone in another room, tell everybody at home that you are not to be disturbed for at least 10-15 minutes, and just remain one-on-one with you and your face. So listen to your face, focus on what your face is trying to tell you.

Your face always has a message. It is a challenge to hear that message. Some of your muscles may be more tense, some of them more relaxed. Somewhere there can be imbalance in your facial movements. Listen to it. Try to rebalance it.

Try to relax your facial muscles to such an extent that you will feel your face in equilibrium, in balance, and you will experience your face as one whole, instead of one good side and one bad side.

29. I went through a left ear stepdectomy surgery in 2019 April and within 1 week of my surgery I developed Bell’s palsy. Presently I’m 90% recovered. But now, when I smile, my affected side eye becomes small.

Most probably, your facial palsy was the result of post-surgical swelling. If you had stepdectomy, then surgical intervention was in where the facial nerve is running on its way to the face. So probably you had a compression of the facial nerve by the swollen tissue, and that has resulted in facial palsy.

“90% recovered” – great recovery – “when I smile, my affected side eye becomes smaller”. Actually, there is no question here, there is just a statement, but I believe you ask “why?”. When your eye fissure narrows when you move muscles around the mouth, this is called oral-ocular synkinesis. So the symptom that you describe is synkinesis. There are many questions about which talk about this synkinesis, please take a look.

30. I have heard that once new nerves have sprouted to new areas causing synkinesis this cannot be reversed. Is this true?

Well, only He knows what is true. We think it is not the case. The prevailing opinion about the cause for synkinesis is aberrant regeneration, or mis-wiring.

We are of a totally different opinion. There are a lot of reasons for that. The main opinion is that if it were the case, then every time, every result of that mis-wiring, would be different. Because it is random.

However, what we observe, in each and every case, is that the manifestations of complications after Bell’s palsy are exactly the same: ocular-oral synkinesis; oral-ocular synkinesis; smaller eye fissure, deeper nasolabial fold, dimples in the chin. Quite often – inability to lift the eyebrow, and so on. Imbalance in facial movements. So it is exactly the same and could be predicted quite precisely. Not the intensity, but the nature of complication.

That gives us a direct reason to conclude that is not a random process unlike aberrant regeneration, which is a random process.

31. I developed Bell’s palsy on June 5, 2022, took 6 weeks to recover movements. Will contractures continue to improve, or do I need to implement another treatment to stop contracture from becoming permanent?

You are now on the 5th month of your disorder. “Will contractures continue” – from what you say, I conclude that you started to feel that your muscles on the affected side start to develop some excessive tension compared to your healthy side.

“Do my contractures continue to improve”. Your facial movements – the ability of your muscles to contract – are likely to get better and stronger. Because the connection between your brain and your muscles gets better as the time goes.

If you have started to develop those complications which I mentioned – hypertone, extra tension, synkinetic contractions of your facial muscles -they are not likely to disappear by themselves.

You can try keeping your face relaxed as much as possible. Do gentle facial massages. These can somewhat reduce the intensity of the tension over time.

If you want a more detailed analysis of your situation, or later on, when it becomes evident that your improvements have reached the saturation point, or when you see that your condition has reached a certain plateau, please register for a video diagnostic session, so we can discuss your case individually and see how we can help you.

32. ​I have had Bell’s palsy 4 times, this is the first time there has been significant pain, I am using your massage and mind therapy techniques as discussed on your website. Is pain normal?

Depends on where your pain is. If you are at the early stage of your Bell’s palsy – a couple of weeks or a couple of months – and your pain is not behind your ear but in your face, then as controversial as it may sound, it may be a sign of recovery.

On the other hand, the pain, if you feel it in the area just above the eyebrow, around or under your eye, around the lower part of your chin, then it can be a result of what I call – micro-cramps.

Some of the fibres of your facial muscles may be receiving cramp-like continuous signal from the brain like “Go! Go! Go!”, and then they will cramp. Not the whole muscle, but certain fibres of that muscle can cramp, and that is painful also by itself and also the the touch.

Just like with any other cramp, you should try massaging it (very gently), make it warm.

33. Should I expect additional synkinesis after observing crocodile tears?

Well, these two symptoms are not related to each other. Not necessarily that the fact of having Crocodile Tears will also cause other synkinesis. It also depends on what stage you are in. Excessive tearing can also happen during the acute stage of facial palsy. Because the tear gland is also innervated by the facial nerve.

If there are any irregularities in the function of that nerve, tear gland may produce excessive tears, or that little tear sack, as mentioned in question 23, may not be receiving proper innervation.

I see now that you are on your 4th month since the onset. Usually, it is the period when the synkinesis start to form. They may start to form a little earlier, but usually between 4 and 6 months.

Again, general recommendation, maintain your facial relaxation, try to avoid your brain, so to say, from developing a habit of pushing your muscles all the time in an excessive intensity. Because that “shouting” to the muscles by your brain, is – from our point of view – the main reason for forming of synkinesis.

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Alex Pashov

Co-founder of Crystal Touch clinic and Bell's palsy expert.

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