Selective Neurectomy(Permanent Relief for Synkinesis)
A highly specialized surgical procedure to permanently release facial tightness, stop involuntary spasms, and restore a balanced, unhindered smile.
In a Nutshell
- What it is: A microsurgery that precisely cuts "miswired" nerve branches causing tight, fighting muscles.
- Who it's for: Patients with long-standing synkinesis (from Bell's palsy, trauma, etc.) who are tired of returning for frequent Botox injections.
- The Outcome: Permanent release of facial tension, reduction in spasms, and a freer, more symmetric smile.
What is a Selective Neurectomy?
When a facial nerve recovers from an injury (such as Bell's palsy or trauma), the nerve fibers can grow back improperly and connect to the wrong muscles. This "miswiring," known as Synkinesis, causes muscles to fight against each other. The result is chronic facial tightness, pain, an inability to smile fully, and involuntary movements (like the eye squeezing shut when chewing).
While Botox is highly effective at temporarily weakening these miswired muscles, the results wear off every few months. Modified Selective Neurectomy is the surgical, definitive alternative.
During this intricate microsurgery, Dr. Jowett meticulously maps the facial nerve network using electrical stimulation. He then selectively cuts (releases) the specific, microscopic nerve branches that are causing the unwanted tension, such as the branches pulling the mouth downward or the neck bands tightly inward, while carefully preserving the healthy branches necessary for your smile and eye closure.
Conditions Treated with Selective Neurectomy
Selective Neurectomy is typically reserved for patients suffering from long-standing, severe post-paralytic synkinesis who have experienced relief from Botox but desire a permanent solution.
Chronic Bell's Palsy
Severe, unresolving facial tightness and miswiring years after onset.
Facial Nerve Trauma
Nerve cross-wiring following a severe crush injury or surgical repair.
Acoustic Neuroma
Post-operative synkinesis from tumor resection recovery.
Ramsay Hunt Syndrome
Deep facial aching and restriction following viral damage.
The Permanent Relief It Provides
- Long-Term Facial Comfort: Permanently releases the constant, aching cramp in the cheek and neck caused by muscles firing against each other.
- Unleashing the Smile: By permanently disconnecting the "depressor" muscles that pull the mouth down, your upward smile muscles are finally free to lift without resistance.
- Improved Resting Symmetry: Relaxes the hyper-contracted side of the face so it no longer looks "pulled" or tight when you are simply resting.
- Freedom from Injections: Replaces the need to visit the clinic every 3-4 months for therapeutic Botox injections.
The Technique: Intraoperative Precision
Selective Neurectomy is considered one of the most intricate and delicate procedures in facial plastic surgery. It requires operating through discreet incisions (often hidden in the natural creases of the face and neck, similar to a facelift approach).
Dr. Jowett locates the complex web of facial nerve branches under high magnification. Using a highly sensitive electrical nerve stimulator, he tests each individual branch. If stimulating a specific branch causes the neck to tighten downward or the eye to squeeze shut forcefully, he selectively cuts that branch. If a branch correctly triggers the smile, it is carefully preserved. This "Modified" approach ensures that functional movement is enhanced rather than weakened.
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation and is among a highly exclusive group of surgeons globally who routinely perform the Modified Selective Neurectomy.
Because this procedure involves intentionally cutting nerves, it requires an extraordinary level of anatomical mastery, precision, and judgment. Dr. Jowett uses Botox as a diagnostic "test run" before offering this surgery: if Botox successfully relieves your tightness by temporarily paralyzing specific muscles, he can confidently use Selective Neurectomy to provide that exact same relief, permanently.
Selected References
- Effect of Weakening of Ipsilateral Depressor Anguli Oris on Smile Symmetry in Postparalysis Facial Palsy. Jowett N, Malka R, Hadlock TA. JAMA Facial Plast Surg. 2017 Jan 01; 19(1):29-33. doi: 10.1001/jamafacial.2016.1115. PMID: 27658020.
- Weighting of Facial Grading Variables to Disfigurement in Facial Palsy. Banks CA, Jowett N, Hadlock CR, Hadlock TA. JAMA Facial Plast Surg. 2016 Jul 01; 18(4):292-8. doi: 10.1001/jamafacial.2016.0226. PMID: 27124886.