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What Causes Drooping On One Side Of Face?
Question: Hello, Ive been on this website many times before but I need help, none of my doctors have been able to help me. Ok so basically the right side of my face has changed and i do not know why, it doesnt have a significant droop like you would get with bells palsy but it has changed to what it looked like a day before the change occured. It is so minor that most people would be able to get on with their lives, however I cannot because looks and make up is very important to me because make-up is my passion and now when i put make-up on i hate it because i dont look good anymore, I am even considering surgery. This happened after a weekend of heavy alcohol use. I do not know what the cause of this is?!! Someone please help and what should I do to get my face back to normal? I have attached two images of my nose one was before and the other one is after. You can see on the after pic the right nostril looks like it is being pulled. I can move my muscles on my face perfectly so i know i do not have any paralysis. Can you please tell me what I can do to get my nose back to normal or will I have to resort to surgery?
Brief Answer:
Could you please confirm the side of the face involved?looks left to me
Detailed Answer:
Hi XXXXXXX
I understand your concern.
Could you please confirm the nasal deformity you are referring to?
From the pic I could notice the left nostril of yours being pulled a bit away.
I need the sidedness from your own look.Not the mirror look.
Also please name the images as Before and After.
Thank you.
Could you please confirm the side of the face involved?looks left to me
Detailed Answer:
Hi XXXXXXX
I understand your concern.
Could you please confirm the nasal deformity you are referring to?
From the pic I could notice the left nostril of yours being pulled a bit away.
I need the sidedness from your own look.Not the mirror look.
Also please name the images as Before and After.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi its the right side but in the image(18) which is the before picture the right nostril which is the affected nostril is seen on the left hand side. Also in image5 the right nostril which is seen is the affected side and is the after picture. Sorry for the confusion as the first picture was taken from the laptop and the other from my XXXXXXX
Brief Answer:
You can get your normal shape of the nose back.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
As per the uploaded images,You seem to have Grade 1 Idiopathic facial nerve paralysis otherwise referred to as Bells Palsy.Severity is graded from 1-6.
Grade 1 represents palsy with normal function of facial muscles over all.
This is the state which you are currently in.
The major cause of Bells palsy in your case can be attributed to possible alcohol induced polyneuritis.A possible latent (self)viral reactivation causing inflammatory facial nerve damage can be a 2nd major concern.
No further diagnostic tests are needed in your case since the onset is relatively very short.
Prognostically you can be placed in Group 1 patients-in whom complete clinical recovery is expected implies,the right nostril pull will settle without any residual dysfunction.
90% Of the patients recover within the time limit of 6 weeks- 3 months.
The first sign of 100% recovery is some degree of correction of disfigurement occurs by 3rd week.
The need for surgery in your case is zero as complete recovery is the rule in you.
The need for surgery arises only if the facial/nostril disfigurement persists beyond 3rd month. But I do understand your need and wish for superior cosmetic look.
Good surgical options are available ,hence you need not be excess worried.
Currently you can be prescribed tab Predisolone 25 mg PO twice a day for 5 days followed by tapering of the dose in the next 5 days,a total of 10 days.
Please note this drug has to be taken only under strict medical prescription.
There is provision to monitor the nerve recovery through serial EMG/electromyography of the involved muscles.
Botox toxin injection subcutaneously over the involved muscle can also produce prompt results as an alternate to any surgical procedure.
Hence I finally sum up within an advise to wait till 3 months of symptom onset before proceeding to any surgical procedure
Post your further queries,if any.
You can get your normal shape of the nose back.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
As per the uploaded images,You seem to have Grade 1 Idiopathic facial nerve paralysis otherwise referred to as Bells Palsy.Severity is graded from 1-6.
Grade 1 represents palsy with normal function of facial muscles over all.
This is the state which you are currently in.
The major cause of Bells palsy in your case can be attributed to possible alcohol induced polyneuritis.A possible latent (self)viral reactivation causing inflammatory facial nerve damage can be a 2nd major concern.
No further diagnostic tests are needed in your case since the onset is relatively very short.
Prognostically you can be placed in Group 1 patients-in whom complete clinical recovery is expected implies,the right nostril pull will settle without any residual dysfunction.
90% Of the patients recover within the time limit of 6 weeks- 3 months.
The first sign of 100% recovery is some degree of correction of disfigurement occurs by 3rd week.
The need for surgery in your case is zero as complete recovery is the rule in you.
The need for surgery arises only if the facial/nostril disfigurement persists beyond 3rd month. But I do understand your need and wish for superior cosmetic look.
Good surgical options are available ,hence you need not be excess worried.
Currently you can be prescribed tab Predisolone 25 mg PO twice a day for 5 days followed by tapering of the dose in the next 5 days,a total of 10 days.
Please note this drug has to be taken only under strict medical prescription.
There is provision to monitor the nerve recovery through serial EMG/electromyography of the involved muscles.
Botox toxin injection subcutaneously over the involved muscle can also produce prompt results as an alternate to any surgical procedure.
Hence I finally sum up within an advise to wait till 3 months of symptom onset before proceeding to any surgical procedure
Post your further queries,if any.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I visited my neurologist today and I mentioned the assymetry and she said everything is in normal lengths. But it's not normal! I don't know what to do anymore
Brief Answer:
Surgical procedures can prove curative in your case.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
I have gone through your uploaded image as well.
I observe in the residual asymmetry, in your face which is subtle but bothering you a lot
If the asymmetry has not resolved for 5 months,its advisable to have a surgical procedure.
Procedures which can offer great success in your case are.
Facial nerve decompression after a preliminary MRI scan to identify the location
Sub orbicularis fat lift procedures.
You need to consult an ENT surgeon and a Cosmetic/Plastic surgeon who has expertised in surgeries on facial nerve,instead of neurologist.
Expertised management will offer excellent results in your case,hence I advise you not worry on the outcome of the surgical procedure.
Thank you.
Surgical procedures can prove curative in your case.
Detailed Answer:
Hi XXXXXXX
I understand your concern.
I have gone through your uploaded image as well.
I observe in the residual asymmetry, in your face which is subtle but bothering you a lot
If the asymmetry has not resolved for 5 months,its advisable to have a surgical procedure.
Procedures which can offer great success in your case are.
Facial nerve decompression after a preliminary MRI scan to identify the location
Sub orbicularis fat lift procedures.
You need to consult an ENT surgeon and a Cosmetic/Plastic surgeon who has expertised in surgeries on facial nerve,instead of neurologist.
Expertised management will offer excellent results in your case,hence I advise you not worry on the outcome of the surgical procedure.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Is there anyway to make it go back to normal without surgery? Also, why hasnt it gone away yet? Does this mean it is permanent?
Brief Answer:
Possible permanent deformity.
Detailed Answer:
Hi XXXXXXX
I understand your query and concern.
As almost 5 months have elapsed without complete recovery,its advisable to take up surgery for cosmetic reasons.
Alternatively Botox toxin injection will help as explained earlier.
The residual facial deficit, could have resulted from permanent microscopic neuronal death of the facial nerve. It could possibly be a permanent deformity.
Surgery can definitely reverse this deformity.
Thank you.
Possible permanent deformity.
Detailed Answer:
Hi XXXXXXX
I understand your query and concern.
As almost 5 months have elapsed without complete recovery,its advisable to take up surgery for cosmetic reasons.
Alternatively Botox toxin injection will help as explained earlier.
The residual facial deficit, could have resulted from permanent microscopic neuronal death of the facial nerve. It could possibly be a permanent deformity.
Surgery can definitely reverse this deformity.
Thank you.
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Thank you. But im scared that I may look worse than before.
Brief Answer:
Expert Facial Nerve surgeon is needed.
Detailed Answer:
Hi XXXXXXX
You need not be concerned over the outcome of the surgery,as successful,precise results are very much possible in experienced hands.
Microsurgical techniques employing a High resolution microscope is applied in your case to deal with the issue.
Hence I strongly recommend you to consult a doctor who has expertise in Facial Nerve surgeries mainly.
Thank you.
Expert Facial Nerve surgeon is needed.
Detailed Answer:
Hi XXXXXXX
You need not be concerned over the outcome of the surgery,as successful,precise results are very much possible in experienced hands.
Microsurgical techniques employing a High resolution microscope is applied in your case to deal with the issue.
Hence I strongly recommend you to consult a doctor who has expertise in Facial Nerve surgeries mainly.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I do not think doctors will accept my case because it looks more or less normal to doctors.
Brief Answer:
Explain your cosmetic importance to your doctor.
Detailed Answer:
Hi XXXXXXX
Yes certainly ,I understand your concern.
Medically there is no indication for surgery in your case.
Its only for a cosmetic reason that surgery can be opted for.
Hence it finally depends on you to whether go for or not.
In case if you really wanted it,then you need to explain the same to your cosmetic surgeon and convince him/her.Thats it.
Hence think for yourself and make an apt decision.
Thank you.
Explain your cosmetic importance to your doctor.
Detailed Answer:
Hi XXXXXXX
Yes certainly ,I understand your concern.
Medically there is no indication for surgery in your case.
Its only for a cosmetic reason that surgery can be opted for.
Hence it finally depends on you to whether go for or not.
In case if you really wanted it,then you need to explain the same to your cosmetic surgeon and convince him/her.Thats it.
Hence think for yourself and make an apt decision.
Thank you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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