Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty



Synkinesis is a recognized complication following peripheral facial nerve paralysis. Different types of synkinesis have been described, with oral–ocular and ocular–oral synkinesis being the most common. Ocular–nasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between the orbicularis oculi and procerus muscles has not been reported by now.


This is an interventional case report.


Two women, aged 42 and 37 years, presented with unilateral contraction of the medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, 4 and 5 months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A.


Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of the facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of the facial nerve and prevent subsequent aberrant innervation and synkinesis. Botulinum toxin A injection can effectively, yet temporarily, resolve the unintentional contractions and provide significant patient comfort.

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  1. 1.

    Crumley RL (1979) Mechanisms of synkinesis. Laryngoscope 89:1847–1854

    CAS  PubMed  Google Scholar 

  2. 2.

    Choi D, Raisman G (2002) Somatotopic organization of the facial nucleus is disrupted after lesioning and regeneration of the facial nerve: the histological representation of synkinesis. Neurosurgery 50:355–362

    PubMed  Google Scholar 

  3. 3.

    Kalantar Motamedi MH, Ebrahimi A, Shams A, Nejadsarvari N (2016) Health and social problems of rhinoplasty in Iran. World J Plast Surg 5:75–76

    PubMed  PubMed Central  Google Scholar 

  4. 4.

    Kayabaşoğlu G, Dizdar D (2017) An effective technique for nasal radix reduction in septorhinoplasty: procerus muscle resection. J Craniofac Surg 28:2143–2144

    Article  PubMed  Google Scholar 

  5. 5.

    Batioglu-Karaaltin A, Karaaltin MV, Uzun N, Adatepe T, Ozdemir G, Ertas B (2015) Effects of open technique rhinoplasty on mimicry: electroneurographic evaluation. J Craniofac Surg 26:1348–1351

    Article  PubMed  Google Scholar 

  6. 6.

    Ross AH, Elston JS, Marion MH, Malhotra R (2011) Review and update of involuntary facial movement disorders presenting in the ophthalmological setting. Surv Ophthalmol 56:54–67

    Article  PubMed  Google Scholar 

  7. 7.

    Moran CJ, Neely JG (1996) Patterns of facial nerve synkinesis. Laryngoscope 106:1491–1496

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Husseman J, Mehta RP (2008) Management of synkinesis. Facial Plast Surg 24:242–249

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Rahman I, Sadiq SA (2007) Ophthalmic management of facial nerve palsy: a review. Surv Ophthalmol 52:121–144

    Article  PubMed  Google Scholar 

  10. 10.

    Markey J, Loyo M (2017) Latest advances in the management of facial synkinesis. Curr Opin Otolaryngol Head Neck Surg 25:265–272

    Article  PubMed  Google Scholar 

  11. 11.

    Maria CM, Kim J (2017) Individualized management of facial synkinesis based on facial function. Acta Otolaryngol 137:1010–1015

    Article  PubMed  Google Scholar 

  12. 12.

    Dutton JJ (2011) Atlas of clinical and surgical orbital anatomy, 2nd edn. Elsevier Saunders, Philadelphia

    Google Scholar 

  13. 13.

    Caminer DM, Newman MI, Boyd JB (2006) Angular nerve: new insights on innervation of the corrugator supercilii and procerus muscles. J Plast Reconstr Aesthet Surg 59:366–372

    Article  CAS  PubMed  Google Scholar 

  14. 14.

    Guarro G, Brunelli F, Rasile B, Alfano C (2017) Oculonasal synkinesis: video report and surgical solution of a rare phenomenon. Aesthet Surg J 37:879–883

    Article  PubMed  Google Scholar 

  15. 15.

    Kosins AM, Palhazi P (2017) Commentary on: oculonasal synkinesis: video report and surgical solution of a rare phenomenon. Aesthet Surg J 37:884–886

    Article  PubMed  Google Scholar 

  16. 16.

    Guyuron B, Bokhari F, Galloway DV, Thomas T (1994) Oculonasal synkinesis. Plast Reconstr Surg 94:251–253

    Article  CAS  PubMed  Google Scholar 

  17. 17.

    Cakir B (2016) Aesthetic Septorhinoplasty. Springer, New York

    Google Scholar 

  18. 18.

    Axelsson S (2013) Bell’s Palsy—medical treatment and influence of prognostic factors. Faculty of Medicine Doctoral Dissertation Series 2013, Lund University, p 49

  19. 19.

    May M, Schaitkin BM (2000) The facial nerve. Thieme, New York

    Google Scholar 

  20. 20.

    Borodic G, Bartley M, Slattery W, Glasscock M, Johnson E, Malazio C, Goodnough M, Acquadro M, McKenna M (2005) Botulinum toxin for aberrant facial nerve regeneration: double-blind, placebo-controlled trial using subjective endpoints. Plast Reconstr Surg 116:36–43

    Article  CAS  PubMed  Google Scholar 

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The authors appreciate the expert advice by Professor Keyvan Aghazadeh on this paper.

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Correspondence to Hadi Ghadimi.

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All procedures performed in participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Eshraghi, B., Ghadimi, H., Nikdel, M. et al. Synkinesis Between Orbicularis Oculi and Procerus Muscles: Video Presentation of an Unusual Type of Aberrant Innervation after Cosmetic Rhinoplasty. Aesth Plast Surg 43, 98–101 (2019).

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  • Esthetics
  • Botulinum toxin type A
  • Facial nerve
  • Rhinoplasty
  • Synkinesis