Stanford Facial Nerve Center


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What is Synkinesis?

Some patients who have previously had Bell’s palsy or other reversible forms of facial nerve injury may go on to develop synkinesis.  Synkinesis describes unwanted contractions of the muscles of the face during attempted movement.  Commonly, patients will notice forceful eye closure when they attempt to smile, or other muscle spasms during routine facial movements. It is essentially a “faulty re-wiring” of the facial nerve that occurs after injury and recovery. It can significantly impact quality of life and the symptoms do not go away without treatment of some type (see below).


Synkinesis is diagnosed by a history and physical examination.  The incidence of synkinesis is difficult to estimate, since very mild synkinesis may not be easily noticed by physicians or even by patients.   Synkinesis typically does not require an imaging study to diagnose. 


Facial neuromuscular retraining is a specialized form of physical therapy that is unique to facial dysfunction. Rehabilitation specialists guide patients through targeted exercises and design an individualized treatment regimen.  The Stanford Facial Nerve Center has a dedicated and experienced expert in facial retraining, Sarah Stranberg, SLP.  Sarah guides patients with particular attention to facial comfort, verbal and non-verbal expression, and facial symmetry.

Synkinesis that does not respond to facial neuromuscular retraining may benefit from targeted injections of botulinum toxin to ease unwanted facial muscle spasm. It is important to note that the effects of botulinum toxin are temporary, and repeat treatment about every 3 months is needed in order to sustain any benefit gained from botulinum toxin injections. Please see the videos on our site that explain how synkinesis is treated.

Botulinum toxin injections can be a stand-alone therapy for some patients with synkinesis.  For some patients, the temporary relief provided by botulinum toxin can guide their surgeon towards surgical procedures that can provide more long-lasting benefit. These procedures are called selective neurectomy or myectomy. A treatment plan featuring these procedures is individualized and is based on your pattern of facial movement, as well as your response to botulinum toxin injections.