Overview
Synkinesis refers to involuntary facial movements that occur together with intended ones. A common example is the eye narrowing or closing when a person smiles, or the corner of the mouth moving when blinking. It usually develops months after a facial nerve injury, such as Bell's palsy or Ramsay Hunt syndrome.
The problem arises during nerve healing. As fibers regrow, some reconnect to the wrong muscles, so a single intended movement triggers several muscles at once. The result can be facial tightness, asymmetry, discomfort, and movements that feel out of the person's control.
Synkinesis can be treated rather than simply tolerated. A combination of facial retraining, chemodenervation with botulinum toxin, and, in selected cases, surgery is often used to improve facial balance and comfort.
Symptoms
The hallmark is linked movement, such as the eye narrowing when smiling or eating, or the mouth twitching when blinking. The neck band (platysma) may tighten during expression.
Many people also notice facial tightness, fatigue, and a sense that one side of the face is pulled or restricted. Some experience excess tearing during eating, sometimes called crocodile tears.
Living with synkinesis? The next step is a quiet, unhurried conversation.
Causes and risk factors
Synkinesis results from aberrant regeneration of the facial nerve. After injury, regrowing nerve fibers can connect to muscles they did not originally control, so a single command activates several muscles at once.
It is more likely after more severe facial nerve injuries and typically appears several months into recovery rather than immediately.
How it is diagnosed
Diagnosis is based on the history of prior facial weakness and an examination that observes the face at rest and during specific movements. The clinician notes which movements trigger unwanted activity and grades the pattern and severity.
This assessment guides which muscles are overactive and helps plan retraining and any injections or procedures.
Treatment options
Treatment is usually combined and individualized:
- Facial neuromuscular retraining with a trained therapist
- Botulinum toxin to relax specific overactive muscles
- Biofeedback and home exercises to improve coordination
- Selective denervation in selected cases
- Surgical release or nerve procedures for cases that do not respond
- Eye care coordination when blinking and closure are affected
The goal is improved symmetry, comfort, and more natural movement rather than complete elimination of every linked movement.
When to seek care
Consider evaluation when linked movements, tightness, or discomfort develop after facial nerve recovery and interfere with expression, eating, or eye comfort. Treatment can begin once the pattern is established.
If eyelid closure or eye comfort is affected, earlier evaluation helps protect the eye surface.
Clinical references
Medical review
This page is a patient-education resource reviewed by the responsible Norelle Health clinician before publication. It does not replace an in-person evaluation. If symptoms are severe or rapidly worsening, seek immediate medical care.
Specialists who treat synkinesis
Dr. Rakhna Araslanova
MD, FRCSC, FACS
Fellowship-Trained Facial Plastic & Reconstructive Surgeon — Facial Paralysis and Reanimation
Dr. Rakhna Araslanova is a fellowship-trained facial plastic and reconstructive surgeon who leads facial paralysis and reanimation at Norelle Health, with additional expertise in craniofacial reconstruction and aesthetic facial plastic surgery.
- Facial paralysis rehabilitation and surgical reanimation
- Craniofacial reconstruction
- Aesthetic facial plastic surgery
- Rhinoplasty
Also caring for this area
Not sure who to see? Our patient coordination team can help match you with the right specialist.
(212) 444-8006Frequently Asked Questions
Synkinesis is involuntary movement of one part of the face when you intentionally move another, such as the eye narrowing when you smile. It develops as the facial nerve heals after an injury and some fibers reconnect to the wrong muscles.
During recovery from Bell's palsy or other facial nerve injuries, regrowing nerve fibers can connect to muscles they did not originally control. As a result, a single intended movement activates several muscles at once. It usually appears months after the initial weakness.
Yes. A combination of facial neuromuscular retraining, botulinum toxin injections, and, in selected cases, surgery can improve symmetry and comfort. Treatment is individualized to the pattern of overactive muscles.
Small, targeted injections relax specific overactive muscles, reducing unwanted linked movements and tightness. Treatment is usually repeated periodically and is often combined with facial retraining.
Established synkinesis tends to persist without treatment, though its severity varies. Therapy and other treatments can reduce its impact, even when some linked movement remains.
It is a specialized form of facial physical therapy that uses guided exercises, often with mirror or biofeedback, to help you regain more coordinated, balanced movement and reduce unwanted co-contraction.
In selected cases that do not respond to therapy and injections, procedures such as selective denervation or muscle release can reduce overactivity. These options are considered after more conservative measures.
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