Thank you for your question. You submitted a photo which shows the right side of your
face drooping and you state in your question that you had 200 units of Botox™ and now
the right side of your face feels as you state dead and apparently is paralyzed. The reason
you got the Botox™ was for facial spasm.
Well certainly, I can give you some perspective on what my assessment would be in the absence
of a physical examination or reviewing your previous doses. Just a little bit of background,
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years. And my
with Botox™, it ranks as one of the oldest because the original group of doctors using
Botox™ where neurologists and ophthalmologists. And coming from an ophthalmology background
and then oculoplastic surgery, before Botox™ cosmetic surgery even existed, there was Botox™
for the treatment strabismus, for the treatment of blepharospasm and for the treatment of
hemifacial spasm.
Botox™ was originally really considered as an orphan drug, a drug that was going to
have limited application for very specific neurologic conditions. So, I had a lot of
experience with those neurologic conditions from 1993 onwards and I would just venture
to a conjecture that your condition of muscle spasm is a condition called hemifacial spasm.
Essentially, the muscles are contracting out of control in a way that it causes discomfort
and affects your functionality. Now in my experience, whether hemifacial spasm or blepharospasm,
the doctor who is treating you probably has treated you for a long time and in many cases
in many years. The patients I have, in particular patients who have blepharospasm, their charts
are very thick because they had to come in on a regular bases to have Botox™, for example
for both eyes, and it is easy to go through 100 units of benign essential blepharospasm.
But with conditions like hemispasm, there is a little bit more finesse to try to avoid
the situation where you over correct.
Now as you well know, Botox™ is a temporary treatment and that eventually, over several
months things, will get better but I would say and advice you to reach out to your doctor
as soon as possible. There are things that concern me about your situation. Essentially,
when you have relative overcorrection, you are dealing with for all intensive purposes,
facial nerve palsy. And the things that make me most concerned about facial nerve palsy
is eye exposure. When the nerves are relaxed or paralyzed in a way that you are unable
to blink completely, then your eyes can be exposed that you can actually affect the health
and the integrity of the eye. So reaching out with your doctor, checking and maybe seeing
an ophthalmologist to make sure that your eyes are being protected and you may need
to use artificial tears, ointment and maybe tape to protect your eyes when you sleep.
Now as far as the other levels of functional situation you are going to face, the same
challenges on somebody who has bell's palsy or who’s had a stroke, who’s had facial
nerve paralysis has to face and that does also include oral function. So it gets back
to having this question to discuss with your doctor. Yes, within a couple of months, Botox™
will wear off and in the meantime you have to preserve the functionality of the critical
areas. And certainly from my perspective, the eyes are very important in terms of your
ability to see moving forward. Exposure of the eye resulting in dryness or loss of integrity
of the corneal epithelium, you could go so far as getting an infection. So this is something
that needs to be addressed sooner rather than later. So meet with your doctor, figure out
what happened and your doctor needs this information in order to plan your treatment in the future.
So I hope that was helpful, I wish you the best of luck and thank you for your question!