About the Procedure
Selective denervation, sometimes called selective neurolysis, is a procedure used to treat facial synkinesis, the unwanted linked movements that can develop after the facial nerve recovers from an injury such as Bell's palsy, Ramsay Hunt syndrome, or nerve trauma. In synkinesis, attempting one movement triggers another, for example the eye narrowing or the neck tightening when smiling.
During selective denervation, the surgeon identifies and divides specific overactive branches of the facial nerve that drive these unwanted movements, while preserving the branches needed for purposeful expression. The goal is to relax muscles that pull against the smile and to improve facial balance and comfort.
At Norelle Health, selective denervation is considered as part of a broader facial reanimation plan. It is usually combined with facial physical therapy and, in many patients, follows or works alongside other treatments such as botulinum toxin injections.
Who may be a candidate
Selective denervation may be considered for people with facial synkinesis that remains bothersome despite facial physical therapy and botulinum toxin injections. Common patterns include the eye narrowing when smiling, neck banding (platysmal) tightness, or the corner of the mouth being held down by opposing muscles.
Candidacy depends on the specific muscles involved, the cause and timing of the original nerve injury, and overall facial function. It is determined after evaluation by a facial nerve specialist, often with photographs and video of facial movement.
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How it is performed
The surgery is performed through incisions placed in natural creases, often near the ear or in the neck, depending on which muscles are targeted. The surgeon identifies the nerve branches supplying the overactive muscles and divides the ones causing the unwanted movement, while preserving the branches needed for purposeful expression.
Selective denervation is sometimes combined with other facial nerve procedures, such as muscle release or, in some patients, a smile-restoration technique, as part of an individualized plan.
Recovery and aftercare
After surgery, some swelling and temporary changes in movement are expected as the muscles adjust. Facial physical therapy is continued to retrain expression and reinforce the new balance.
Improvement in symmetry and a reduction in unwanted movement develop gradually over weeks to months. Botulinum toxin injections may still be used afterward to fine-tune specific muscles.
Risks and alternatives
Possible risks include bleeding, infection, temporary or persistent changes in facial movement, asymmetry, and the chance that some synkinesis remains or that additional treatment is needed. Because the facial nerve is delicate, the procedure is performed with care to preserve useful movement.
Alternatives include continued facial physical therapy and botulinum toxin injections, which are usually tried first, and other facial reanimation procedures depending on the pattern of weakness and synkinesis.
Results and follow-up
The goal of selective denervation is a more balanced, comfortable face with a smile less restricted by opposing muscles. Results build gradually and are supported by ongoing therapy.
Follow-up visits track facial movement, guide therapy, and determine whether botulinum toxin or other adjustments would further refine the result. Synkinesis management is often a long-term, staged process.
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 perform selective denervation
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
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(212) 444-8006Frequently Asked Questions
It is a surgical treatment for facial synkinesis in which specific overactive branches of the facial nerve are divided to relax the muscles causing unwanted movements, while preserving the branches needed for expression.
Synkinesis is the unwanted, linked movement that can develop after the facial nerve recovers from an injury such as Bell's palsy or Ramsay Hunt syndrome. For example, the eye may narrow or the neck may tighten when smiling.
It may be considered for people whose synkinesis remains bothersome despite facial physical therapy and botulinum toxin treatment, depending on the muscles involved and overall facial function.
No. Facial physical therapy and botulinum toxin injections are usually tried first. Selective denervation is considered when these measures are not enough.
Often yes. Facial physical therapy is continued to retrain movement, and botulinum toxin may still be used to fine-tune specific muscles after surgery.
Incisions are placed in natural creases, often near the ear or in the neck, so scars are usually positioned to be discreet.
Improvement in balance and reduction of unwanted movement develop gradually over weeks to months, supported by ongoing therapy.
Bring the history of your facial nerve injury, any prior treatment records, and photographs or videos of your facial movement if available, as these help plan which muscles to target.
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