Incomplete facial paralysis with synkinesis (see text), as with this 70-year-old patient, is a particular challenge. With facial expressions, unwanted concomitant movements of unintentionally controlled muscle groups occur. For example, when smiling or laughing, the patient in the left affected half of her face has an unwanted spastic closure of the left eye and overdrive of the eye ring muscle (picture left and middle). Right picture: Restored symmetry and considerable improvement of the appearance of the smile by treatment with botulinum toxin for the eye complex. In addition, the patient received a transplantation of a muscle from the thigh into the left cheek region for improved control of the corner of the mouth and a face lift.

This patient showed clear synkinesis (unintentional mass movements) of the muscles of the upper and lower third of her face: if she tries to smile, several phenomena unintentionally appear at the same time. The left eye ring muscle involuntarily cramps up, so that the eye appears smaller when smiling or laughing. In addition, the unintentional co-activation of the "lip and corner of the mouth countersink" causes the corner of the mouth to become rather fixed, which limits the lifting of the corner of the mouth. The corner of the mouth therefore tends to point "downwards" in comparison to the untamed right opposite side. Furthermore, an unintentional but clear co-activation of the chin muscle (m. mentalis) is impressive in facial expressions, which is generally referred to as "cobblestone chin". A differentiated and targeted application of botulinum toxin by the specialist solves this problem. A few days later the patient sends a vivid photo by e-mail: the symptoms have disappeared. When smiling, even the corner of the mouth now appears freer, with easier play for the now predominant "corner of the mouth lifters". Even with a strong smile with open lips, the eye remains open and the view remains unobstructed. Also, the unwanted cramping around the chin has completely disappeared. The problem is relieved for several months.