What Are the Stages of Synkinesis?

Synkinesis is a condition many people experience after recovering from facial paralysis, and it can be both puzzling and frustrating. It occurs when facial nerves heal in a way that causes unintended muscle movements. For instance, you might try to smile and find that your eye closes involuntarily, or blink and notice that part of your mouth moves at the same time. At the Hadlock Center for Facial Plastic Surgery in Boston, Dr. Tessa Hadlock, a world-renowned facial nerve specialist, Professor of Otolaryngology at Harvard Medical School, and pioneer in facial reanimation techniques, offers advanced, highly personalized treatments to help patients manage and improve synkinesis. Here’s how this condition typically progresses, and the ways it can be treated at each stage.

Stage One: Nerve Injury and Recovery

The process begins with damage to the facial nerve from conditions such as Bell’s palsy, trauma, or certain surgeries. In the initial recovery phase, the nerve begins to regenerate. While this is encouraging, the regrowth can sometimes result in miswiring, nerve fibers reconnecting in ways that send signals to the wrong muscles. Clear signs of synkinesis may not appear yet, but the groundwork for its development is being laid.

Stage Two: Early Signs of Unintended Movements

As healing progresses, subtle signs may appear, including:

• Mild facial twitching
• Slight asymmetry during expressions
• Blinking that causes the mouth to lift
• Smiling that narrows one eye

Early detection matters. This is often the best time to begin targeted physical therapy to retrain muscles and prevent maladaptive movement patterns from becoming ingrained.

Stage Three: Established Synkinesis Patterns

At this point, misdirected nerve signals produce consistent, predictable involuntary movements. Everyday expressions like smiling, speaking, or showing emotion can become challenging, sometimes affecting self-confidence. At the Hadlock Center, treatment often includes:

• Customized neuromuscular retraining exercises designed for your unique movement patterns
• BOTOX injections to relax overactive muscles and restore balance
• Advanced surgical procedures, including Dr. Hadlock’s innovative nerve rerouting techniques

Stage Four: Long-Term Management and Improvement

This stage is about maintaining progress and refining results. With the right care plan, many patients experience substantial improvement in facial control and symmetry. Ongoing treatment may include:

• Periodic BOTOX sessions for targeted muscle modulation
• Continued, tailored physical therapy for lasting gains
• Cutting-edge facial reanimation procedures developed and taught by Dr. Hadlock to specialists worldwide

The goal is to achieve a natural, expressive appearance while minimizing or eliminating the impact of synkinesis.

Partner with the Hadlock Center for Your Recovery

With decades of clinical excellence, leadership at Harvard, and internationally adopted innovations in facial nerve care, Dr. Hadlock and her team at the Hadlock Center provide some of the most advanced, evidence-based treatments available. Whether you’ve just started noticing changes or have been living with synkinesis for years, expert care can help you smile, speak, and express yourself with greater confidence.

Schedule your consultation with the Hadlock Center for Facial Plastic Surgery in Boston today, and take the next step toward restoring natural movement and quality of life.