Synkinesis can be reduced, but there is no quick fix. The main options are facial retraining, Botox injections, surgery and specialised rehabilitation. Botox gives fast but temporary relief. Retraining and rehabilitation work on the brain’s control of the face, take months, and aim for a lasting change. Surgery is kept for selected cases.
Table of contents
The options at a glance
| Treatment | What it does | How long the effect lasts | Main downsides |
|---|---|---|---|
| Facial retraining (physiotherapy, biofeedback) | Teaches you to control which muscles move, often with mirror or EMG feedback | Can last, if you keep practising | Takes months. Can make the affected side less expressive |
| Botox injections | Blocks the signal to overactive muscles | About 3 to 5 months, then it needs repeating | Temporary. Can weaken healthy movement too. Off-label use |
| Surgery (selective neurectomy, myectomy) | Cuts selected nerve branches or removes part of a muscle | Permanent | Irreversible. Limited research. Needs a very experienced surgeon |
| Plastic surgery (lifts, symmetry procedures) | Improves the face at rest | Permanent | Does not help movement. Asymmetry returns when you talk or smile |
| Neuro-Proprioceptive Rehabilitation (our method) | Trains the brain to balance the signals to both sides of the face | Aims to last, as a new habit | Takes 5 to 12 months of daily work, with guidance |
Can synkinesis be corrected?
Yes, in our experience it can be reduced, and in some patients almost fully. But it will not go away on its own, and no treatment fixes it overnight. Synkinesis is a pattern the brain learned during a long recovery. Like any habit, changing it takes time, persistence and guidance. Read What is synkinesis? for why we see it this way.
Facial retraining
Facial retraining (also called neuromuscular retraining or mime therapy) teaches you to move one part of your face without the others. A physiotherapist guides you, often with a mirror or with EMG biofeedback, which shows muscle activity on a screen. Research supports EMG feedback as the most reliable form.
Our view: retraining uses the voluntary control of the face. It can suppress the unwanted movements, but people often learn to hold back the affected side altogether, so the face becomes less expressive. We also avoid general facial exercises, which can make synkinesis worse. Read Facial exercises for Bell’s palsy.
Botox injections
Botox (botulinum toxin) is injected into the overactive muscles, for example around the eye. It blocks the signal from nerve to muscle, so the unwanted movement becomes weaker within days. The effect wears off after about 3 to 5 months, and the injections are repeated.
Our view: Botox is useful relief, but it does not change the signals from the brain, so the synkinesis returns when it wears off. Read more in Botox injections for synkinesis.
Surgery
In selective neurectomy, the surgeon cuts small nerve branches that drive the unwanted movement. In myectomy, part of an overactive muscle is removed, for example the one that pulls the mouth corner down. Both are permanent and are done by specialised facial nerve surgeons. Research is still limited. Read more in Surgical interventions for Bell’s palsy.
Plastic surgery can make the face look more even at rest. As soon as you speak or smile, the imbalance in movement comes back.
Neuro-Proprioceptive Rehabilitation
Our Neuro-Proprioceptive Rehabilitation method works on the cause as we see it: the brain over-amplifying signals to the affected side. Instead of training muscles, it gives the brain consistent feedback that the extra effort is no longer needed, so the natural movement pattern can return.
- How long: usually 5 to 12 months, depending on how consistently you practise.
- What it asks of you: daily work and strong motivation. Progress is slow at first.
- Where: in our clinic in Rotterdam, online, or a mix of both.
- Results: see our patients’ stories and our research.
You can combine it with Botox, but we usually advise waiting until a Botox injection has worn off, so we can see your real movement pattern.
Which option is right for you?
- You want quick, temporary relief: Botox.
- You want a lasting change and can commit several months: retraining or rehabilitation.
- The nerve was cut (surgery, trauma) or nothing else has helped: ask a facial nerve surgeon about surgical options.
You can also start on your own: What you can do yourself to reduce synkinesis.
Not sure which option fits your face? In a video consultation, Dr. Alex Pashov assesses your synkinesis and explains your options, wherever you live. See also our synkinesis treatment in Rotterdam and online.
It depends on what you want. Botox gives fast, temporary relief. Facial retraining and specialised rehabilitation take months but aim for a lasting change. Surgery is kept for selected cases.
Yes. Most people are treated without surgery, with retraining, rehabilitation, Botox or a combination.
With retraining or rehabilitation, usually 5 to 12 months of daily work. Botox works within days but wears off after about 3 to 5 months.
Yes. When the effect wears off, the muscles receive the same signals as before, so the synkinesis returns unless the cause is treated.
Yes. Selective neurectomy and myectomy are permanent and cannot be undone. That is why they are usually considered only when other treatments have not helped enough.
