Synkinesias after Facial Paralysis: how to improve even years later

Syncinesis is one of the most common sequelae following peripheral facial paralysis. They can appear months after the initial injury and persist for years, interfering with facial expression, symmetry, self-image and quality of life.

Even when facial paralysis occurred several years ago, it is possible to improve muscle control and coordination through specialised physiotherapy in facial neuromuscular re-education.

What are synkinesias?

Synkinesias correspond to involuntary movements that occur during a voluntary facial movement. For example:

• When making the 'beijinho', the eye may close involuntarily
• When blinking, the corner of the mouth can be raised.
• During speech, excessive tension can arise in the jaw or neck.

These movements result from disorganised nerve regeneration after facial nerve injury, leading to crossed and poorly selective signals being sent to different muscle groups.

Why do they persist even years after facial paralysis?

Synaesthesia tends to manifest after the initial phase of facial nerve recovery, although the neural reorganisation process occurs from early stages.

During regeneration, some nerve fibres can reconnect inaccurately, establishing connections with muscles they did not originally innervate. Over time, these patterns become automatic and reinforced by repeated daily use.

Without specialist monitoring, associated movements may persist for many years and intensify with excessive effort, fatigue or stress. Early intervention by a specialist physiotherapist is one of the most relevant strategies for preventing its consolidation.

Is it possible to intervene in synkinesis that dates back several years?

Yes, even when the facial paralysis occurred five, ten or more years ago, it is possible to improve motor coordination, reduce muscle tension and train more selective movements.

The nervous system maintains its capacity for adaptation throughout life, through the mechanisms of neuroplasticity. When guided in a structured way, this capacity can be used to reorganise motor patterns and improve the quality of facial movement.

How does specialised physiotherapy work with synkinesis?

Physiotherapy specialised in facial paralysis focuses on neuromuscular re-education and the reorganisation of motor control.

The intervention may include:

• Selective activation exercises, focusing on quality and precision of movement
• Relaxation techniques and gentle mobilisation to reduce muscle tension
• Self-control and body awareness strategies
• Education to avoid habits that reinforce inappropriate activation patterns

The aim is to reduce involuntary co-contraction, improve facial symmetry and promote greater naturalness in expressions.

What to expect from evolution?

The outcome depends on multiple factors, including the severity of the synkinesis, the time elapsed since the injury, and the individual's engagement in the retraining process.

Many people observe relevant improvements in facial coordination, symmetry, and comfort. Although progress may be gradual, small changes in motor control can have a significant impact on functionality and self-image perception.

When to seek specialist assessment?

It is advisable to seek specialised physiotherapy if:

• Feels constant tension in the face
• Observe involuntary movements when smiling, talking, or blinking
• They had an old facial paralysis and never fully recovered the naturalness of movement.

Although early intervention is important, neuromuscular reorganisation can be worked on even several years after the initial injury.

Understanding synkinesis from an integrative perspective

Synaesthesia is not just an aesthetic alteration. It can affect communication, emotional expression, and psychological well-being.

Specialised physiotherapy in facial neuromuscular re-education allows for the support of muscle control reorganisation, tension reduction, and improved movement quality. At Integrativa, physiotherapy specialising in facial paralysis  It is based on a rigorous clinical assessment of mobility, symmetry, coordination and compensatory patterns, allowing for the outlining of an individualized approach tailored to the stage of each person's progression.

Even when present for several years, synkinesias can be the subject of structured intervention, respecting the complexity of the neuromuscular facial system and individual adaptation rhythms.