What is synkinesis?

During facial nerve recovery, you may notice that some movements return differently than expected. Perhaps your eye narrows when you smile, or your mouth moves when you close your eye.

These involuntary linked movements are called synkinesis.

Synkinesis can develop after Bell’s palsy or another facial nerve injury, and understanding why it happens is an important part of managing facial recovery.

Why does synkinesis happen?

The facial nerve controls many muscles involved in smiling, blinking, speaking and other expressions.

When the nerve is injured and begins to recover, some regenerating nerve fibres may reconnect in ways that cause muscles to activate together.

As a result, when you intentionally make one facial movement, another movement may happen at the same time.

This does not mean that you have done something wrong during your recovery.

What does synkinesis look like?

Synkinesis can appear differently from person to person.

Common examples include:

• the eye narrowing or closing when smiling

• the corner of the mouth moving when blinking

• the chin tightening during certain expressions

• neck muscles becoming more active when smiling

• tightness or pulling on the affected side of the face

Some people experience very subtle changes, while others find that synkinesis noticeably affects their facial expressions.

When does synkinesis develop?

Synkinesis generally appears during the recovery phase, after facial movement has started to return.

It is different from the initial weakness or paralysis caused by Bell’s palsy.

You may first notice that movement is improving, but later realize that certain parts of your face are beginning to move together.

This is one reason facial rehabilitation can change throughout recovery.

Can facial rehabilitation help?

Facial rehabilitation for synkinesis usually focuses on control and coordination rather than strength.

This may involve learning to make smaller, slower movements while reducing unwanted activity elsewhere in the face.

Depending on the individual, treatment can include facial neuromuscular retraining, massage or stretching for tightness and, in some cases, treatments such as botulinum toxin under specialist care.

The right approach depends on your individual movement pattern.

Should you keep doing facial exercises?

If you notice synkinesis, doing more repetitions or making stronger facial expressions is not necessarily helpful.

Instead, it may be useful to reassess how you are practising.

The goal is not simply to create more movement. It is to develop better-controlled movement.

A clinician experienced in facial nerve rehabilitation can assess which muscles are becoming active together and help develop an appropriate plan.

Synkinesis is another stage of the journey

Developing synkinesis can be frustrating, particularly after waiting for facial movement to return.

But it is something that can be addressed as part of facial rehabilitation.

Your needs may simply be different now than they were earlier in recovery.

As your face changes, your approach to recovery can change with it.

If you are experiencing persistent facial weakness, tightness or involuntary facial movements, consider speaking with a healthcare professional experienced in facial nerve disorders for an individual assessment.