What is selective denervation?
A selective denervation, or selective neurectomy, is a procedure intended to improve facial symmetry, balance the smile, and improve facial tightness and pulling in patients with facial synkinesis.
This procedure is performed under general anesthesia. Dr. Yver uses cosmetic facelift incision to access the distal branches of the facial nerve. Up to 12 branches may be identified. Using a nerve stimulator, the favorable branches are identified and preserved, and the unfavorable branches (i.e. the branches contributing to synkinesis) are identified and clipped.
Is selective denervation covered by insurance?
Yes, this procedure is covered by insurance for the indication of facial synkinesis.
What to expect on the day of surgery?
The selective denervation procedure is performed under general anesthesia in the outpatient surgery center. On the day of surgery, you will have a chance to meet with Dr. Yver to ask any questions and sign the necessary paperwork. The surgery typically lasts 3 - 4 hours. Patients can expect to wake up with a dressing around their face, which helps to apply gentle pressure and minimize swelling. Most patients go home the day of surgery without the need for a surgical drain.
What can I expect after surgery?
After surgery, you will be asked to keep your face wrapped for 72 hours. During this time, you may shower from the collarbone down. After 72 hours, the dressing may be removed and you can shower as normal. You will be provided with antibiotic ointment to apply to the sutures. Some facial swelling or minor bruising may be observed in the week after surgery. Patients are encouraged to apply ice for 48 hours after the procedure and to sleep with their head propped up on several pillows, in order to minimize swelling. The stitches may take 10-14 days to fully dissolve. Patients are encouraged to avoid any exercise, heavy lifting, or strenuous physical activity for two weeks after surgery, or until they are cleared at their post-operative visit.
When will I see results?
Although some patients may notice immediate results, in other patients results may not become evident until the 8-week mark. Although selective denervation can dramatically improve muscle coordination and tightness in synkinesis patients, it should not be considered an absolute cure for synkinesis, and as such many patients opt to continue with periodic Botox injections for fine tuning. To optimize outcomes following selective denervation, Dr. Yver will frequently refer patients back to physical therapy once the recovery is complete.
