As a facial nerve heals, some fibres reach the wrong muscles. The eye then narrows when you smile, or the mouth twitches when you blink. Treatment is mostly therapy and small injections rather than surgery.
Synkinesis appears months after facial nerve recovery, when regrowing fibres connect to muscles they were never meant to supply. One intended movement then triggers another. Management combines facial neuromuscular retraining with a therapist and carefully placed botulinum toxin injections. Surgery is reserved for a small number of patients whose tightness does not respond.
When a facial nerve is damaged, the fibres inside it try to grow back towards the muscles they used to supply. The nerve is a bundle, and the regrowing fibres do not always follow their original routes. A fibre that once controlled the corner of the mouth may end up in the muscle that closes the eye, so smiling now narrows the eye as well.
Patterns vary between people. Common ones include the eye closing when the mouth moves, the mouth pulling when blinking, tightness in the neck during expression, and watering of the eye while eating. Many patients also describe a constant ache in the cheek, because muscles that never rest slowly become shortened and tense.
Management works on both sides of that problem. A therapist teaches slow, small, controlled movements in front of a mirror, so the brain learns to separate actions that have become fused. Injections then reduce the pull of the most overactive muscles, which gives the retraining a fair chance to work. Progress is gradual and measured over months rather than weeks.
Management suits anyone whose face has recovered enough to move but now moves in the wrong combinations.
Movements are recorded on video while you smile, blink, speak and eat. Written scoring helps, because linked movements are easier to compare on film than from memory.
The therapist explains why forceful exercise makes matters worse. Practice shifts towards small, slow movements that keep the unwanted partner muscle quiet.
Short daily sessions in front of a mirror teach the brain to separate fused actions. Sessions are brief and frequent rather than long and tiring.
Botulinum toxin is placed in the muscles that pull hardest, often around the eye, chin or neck. Doses start low and are reviewed after about two weeks.
The plan is revisited every few months as the pattern changes. Injections are repeated as the effect fades, and therapy targets are updated.
Assessment, education and the start of retraining. Many patients find the explanation itself a relief, because the tightness finally makes sense.
Injections take effect and tightness eases. Mirror practice becomes easier once the overactive muscles are quieter.
Control improves and linked movements reduce during ordinary conversation. Injections are usually due again towards the end of this period.
Gains are consolidated with continued practice. Most patients settle into a rhythm of therapy reviews and repeat injections.
Linked movements can be reduced considerably, yet they rarely disappear altogether, because the nerve pathways themselves cannot be rerouted. What changes is how much they interfere. With retraining and injections, many patients find the face feels softer, looks calmer in photographs and behaves more predictably in conversation. Progress is measured over months, and keeping up practice between sessions makes a genuine difference to how far it goes.
Therapy carries little risk, while injections have the same considerations as anywhere else on the face.
Daily habits matter here more than in almost any other part of facial palsy care.
Forceful exercise strengthens the wrong connections and usually makes linked movement worse. Slow and controlled practice achieves far more.
It is actually evidence that the nerve regrew. The difficulty is where the fibres ended up, not whether they healed.
Most patients are managed with retraining and injections. Surgery is reserved for a small group whose tightness does not settle with those measures.
Untreated, the pattern tends to become more fixed. Early therapy gives a better chance of gaining useful control.
Elegance Clinic in Surat manages synkinesis as a long term partnership between therapy and injections, and Dr. Ashutosh Shah reviews the pattern on video at each stage rather than relying on recall.
Management is an ongoing programme rather than a one off procedure, so costs are quoted per session. Therapy appointments and injection sessions are listed separately, and the review visit that follows each injection is included. Because the effect of injections fades over months, the likely number of visits in a year is explained at the outset so you can plan sensibly. A written estimate is provided after assessment, and any change in the plan is discussed before it happens.
These are the questions that come up most often in consultation. If yours is not here, send it on WhatsApp and the team will reply, usually the same day.
Ask your question →Because nerve fibres that were meant for the mouth have regrown into the muscle around the eye. The brain sends one instruction and two muscles respond. Retraining and targeted injections reduce how strongly that partner muscle joins in.
Usually not entirely, since the nerve pathways cannot be redirected once they have healed. The realistic aim is much less interference, a softer looking face and better control during conversation, which most patients achieve over months.
Forceful exercise generally makes linked movement stronger, so it is discouraged. Therapy instead uses slow, small and controlled movements in front of a mirror, which teaches the brain to separate actions that have become fused together.
Sessions are quoted individually, covering therapy appointments and injection visits, with the review after each injection included. A written estimate is prepared after assessment, and the likely number of visits across a year is explained upfront.
The effect fades over months, so most patients return two or three times a year once the pattern is settled. Intervals are individual, and the aim is always the lowest dose that keeps tightness comfortably controlled.
Occasionally. A small number of patients whose tightness does not respond to therapy and injections are considered for a procedure that releases or weakens specific muscles. It is discussed only after the simpler measures have been tried properly.
Once linked movements have become established, usually some months after the original weakness. Starting earlier tends to give better control, because patterns become more fixed the longer they go unaddressed. An assessment will confirm the right timing.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
