What is Botox therapy for facial paralysis?
Botox is a selective muscle relaxer that works at the neuromuscular junction to block unwanted muscle activity. Because synkinesis if fundamentally a disorder of too much muscle tone, Botox is particularly effective to relieve some of the most bothersome symptoms of synkinesis, such as tightness/pulling, excessive muscle tone, and facial asymmetry. For patients with flaccid facial paralysis, Botox can be used for contralateral balancing to minimize some of the most obvious asymmetries in facial function.
What is filler therapy for facial paralysis?
As its name suggests, filler is a “space occupier” and can be used to fill areas of the face with insufficient volume. Some patients with facial synkinesis note that their face appears to age asymmetrically, and can therefore benefit from filler to the nasolabial fold or midface area to help mask these asymmetries. Filler around the lips can also be used to help address functional issues associated with facial paralysis such as oral incompetence or difficulties with articulation.
Will my insurance cover Botox or filler?
Botox is covered by the vast majority of insurance companies when used for the treatment of facial paralysis or synkinesis. This typically require a pre-authorization with supportive clinic documentation and photographs. Some insurance companies require the use of Dysport, a cousin of Botox produced by a different manufacturer. Unfortunately, because filler is not typically covered by insurance.
What can I expect at my appointment?
An initial facial paralysis consultation with Dr. Yver is required in order to develop a personalized treatment plan and obtain the necessary clinical documentation needed for pre-authorization. The initial consultation may be in person or via telemedicine. At your first Botox appointment, Dr. Yver will review your facial function and areas of concern in order to develop a preliminary injection pattern. It is OK to wear makeup to this appointment. Using a tiny insulin needle the Botox is injected into the areas of concern, which may include the neck, chin, around the eye, or the forehead. The injections are extremely well tolerated. In rare cases a small bruise may form at the area of injection; ice will help this to resolve in 24-48 hours.
After your Botox appointment, you may resume your normal activities, including exercise. We recommend that you hold off on facials or facial massage for 48 hours after administration of Botox.
After filler injection, it is common to note swelling and sometimes bruising of the area for the first 48 hours. Ice to the affected area and elevation can be extremely helpful. We recommend that you hold off from exercise for 48 hours after your filler appointment to minimize the swelling.
When can I expect to see results?
The effects of Botox can first be noticed 4-5 days after your appointment, and final results are apparent at the 2-week mark. Botox typically lasts about 3 months, and as such most patients undergo Botox injections every 3 months. Your Botox injection pattern may be modified at subsequent appointments based on your changing exam and your feedback. Sometimes it can take a few trials to find the perfect pattern.
The effects of filler are apparent immediately after administration, although it can take up to 5 days for the swelling to go down and to appreciate the final result. Filler typically lasts up to 12 months.
Are there any long-term risks with Botox?
There are no known risks associated with long-term administration of Botox. Botox is helpful as long as it is physiologically active but does not alter the underlying baseline synkinesis.
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