"Can I realistically expect any change so many years after the event, if anything my face seems to be getting worse?"

The face is never static it is always in a state of change.
Mr Sadiq Bana Headline News April 2004 describes the specific changes related to ageing.

If as you claim your face is changing i.e. getting worse then let's grasp the concept of change and train your face to work in such a way that it will always be getting better. The way in which you use your face today determines your future face it can improve.
It is never static and therefore it is totally unrealistic to accept such myths:-

"Where you are 6 months after surgery is where you are going to stay".

"My guess is that you are likely to have to put up with the present state of affairs for life"

The above 2 statements were passed on to me in clinic yesterday please don’t give them any credence. Before we move forward it is always necessary to let go of these concepts of rigidity.

This is certainly the case when we look at patients with "synkinesis" –this is not a disease process it simply describes the situation which exists when the movements in the face link together and it becomes difficult to move the mouth without twitching the eye etc.

"What has gone wrong?"

Nothing has gone wrong it is a natural stage in the recovery process. If the facial nerve is growing back it is impossible to get better without passing through this stage of facial inbalance. When tissues of the body heal they go through various stages of recovery and development before they achieve maturity. This is true for nerves, they grow at a rate of 1mm per day in optimum conditions but the nerve which grows is poorly formed and needs to develop a coating of fatty tissue before it can function independently or to speed.

The regeneration of the facial nerve is miraculous and pleased as you are with it the more your friends say "but you look great now", the more you realise that although it looks ok from the outside it feels very awkward and clumsy to move.

The new nerve is slow to send messages and when the brain says smile the good side wins.

The new nerve is unable to send strong signals independently down any of the 5 branches until the nerve is insulated (i.e. regrows more fatty tissue). The brain says smile and forehead, chin, neck and under eye all twitch together.

Now we reach the real catch 22 situation. To bring the nerve to maturity it needs to function but every time it functions in this immature way the brain receives distorted signals and builds up a distorted image. Long after the nerve reaches maturity the confused brain continues to send distorted messages about how to smile. "This is how we do things now" When asked to smile the eye twitches first it is getting so good at working the wrong way.

We need to work the nerve under gentle load to encourage its maturity. To do this we need to make the face feel relaxed. When it feels good it moves better and we need to bypass the distorted information by feeding in accurate information about how the face is working today. Anything which makes the face feel good will do. Many patients enjoy a facial massage or listening to a relaxation tape. Whatever works for you do more of it.

At the Lindens Clinic we achieve these goals via the following interventions.

Trophic Electrical Stimulation – is specifically applied in order to energise the muscles and gives the nerve a lighter work load. This helps to bring the new nerve to maturity without encouraging mass patterns it is also capable of switching off the unwanted reactions for progressively longer periods of time.Massage – is used specifically to stretch the connective tissue which surrounds the little facial muscles – and tape may be applied to weak muscles in order to prevent them from straining. It is also used to make the face feel good and rebalance the asymmetries

EMG (Electromyography) and biofeedback – are used to display simple graphs on a computer screen to show the way the facial nerve is working in real time. The patient is able to correct and balance the activities in order to master the new movements.

These are the very exciting avenues of facial rehabilitation and the very reason why I enjoy the challenges on a daily basis.

So please laugh out loud when you are told "the nerves have grown down the wrong track".

Your nervous system is amazing and your recovery powers immense. Don't limit your thinking by taking on such negative concerns.