What Is Selective Neurectomy?
Selective neurectomy, also known as selective neurolysis or selective denervation, is a surgical procedure used to treat facial synkinesis.
Facial synkinesis is a common problem after facial nerve damage. It causes facial muscles to move involuntarily, like your eye twitching when you try to smile. These involuntary facial movements can affect confidence, communication, and quality of life.
Selective neurectomy surgery aims to increase facial symmetry, balance the smile, and improve facial tightness and pulling in people with facial synkinesis. It helps by cutting off specific nerve branches that cause unwanted muscle movements.
It can be beneficial for people with facial synkinesiswhose symptoms haven’t improved with nonsurgical treatments.
Why Would I Need Selective Neurectomy?
Your doctor might recommend selective neurectomy surgery if you have facial synkinesis and you are looking for:
- A one-time surgery with faster results than other treatments.
- A customized solution to your unique facial nerve pattern.
- Better smile symmetry.
- Less tightness in facial muscles.
Some patients see improvement immediately after surgery. Sometimes, it can take up to eight weeks to see an improvement. Most people report improved appearance, confidence, and self-esteem as a result of the surgery.
Is selective neurectomy right for me?
This surgery is for people who:
- Didn’t fully recover from Bell’s palsy.
- Have facial synkinesis.
- Struggle with uneven or stiff facial movements.
What Are the Risks and Complications of Selective Neurectomy?
This surgery is generally safe. However, like any surgery, it carries some risks and potential complications.
Common complications include:
- Minor bleeding during surgery.
- Possible need for revision surgery — About 17% of people will need a follow-up procedure to remove more nerve branches if symptoms return or aren’t fully resolved.
- Temporary trouble closing the mouth — About 1 in 10 people may have issues with lip control, speech issues, or drooling after surgery. These symptoms typically improve within three months after surgery.
Rare complications include:
- Facial imbalance — If too many nerves are cut or healing is uneven, it can lead to new asymmetry in facial expressions.
- Open field regeneration — Sometimes, nerves grow back in ways that cause unwanted movements again.
What Should I Expect from Selective Neurectomy?
This procedure is performed under general anesthesia in the outpatient surgery center.
Before surgery
On the day of surgery, you will have a chance to meet with the surgeon and anesthesiologist to ask any questions and sign the necessary paperwork.
- The surgery typically lasts three to four hours.
During surgery
- The surgeon will use a cosmetic facelift incision to access the distal branches of the facial nerve.
- Using a nerve stimulator, up to 12 branches of the facial nerve may be identified and mapped.
- The favorable branches will be identified and preserved. The unfavorable branches (those contributing to synkinesis) will be identified and clipped.
- The platysma, a muscle that pulls the mouth downward, may also be released during the procedure.
- Most patients go home the day of surgery without the need for a surgical drain.
- Patients can expect to wake up with a dressing around their face, which helps to apply gentle pressure and minimize swelling.
- The goal is to restore a spontaneous, balanced smile and to improve muscle tightness and pulling in the lower face and neck.
After surgery
- After surgery, you will be asked to keep your face wrapped for 72 hours.
- During this time, you may shower from the collarbone down.
- After 72 hours, you can remove the dressing and shower as normal.
- You will receive an antibiotic ointment to apply to the sutures.
- You may notice some facial swelling or minor bruising in the week after surgery.
- Apply ice for 48 hours after the procedure, and sleep with your head elevated or propped up on several pillows to minimize swelling.
- The sutures may take 10 to 14 days to fully dissolve.
- Avoid any exercise, heavy lifting, or strenuous physical activity for two weeks after surgery, or until cleared at your postoperative visit.
- Your surgeon may recommend facial retraining exercises to be performed with the guidance of a physical therapist.
- Your doctor may also use Botox to help relax overactive muscles after surgery.
When will I see results?
Some people will notice immediate results, while others may not see their results until the eight-week mark. Although selective neurectomy can dramatically improve muscle coordination and tightness in synkinesis patients, it should not be considered an absolute cure for synkinesis. Many patients still need to continue with periodic BOTOX® injections after surgery.
To optimize outcomes following selective neurectomy, your doctor may refer you to a physical therapist for facial retraining once recovery is complete.
What’s the success rate of selective neurectomy?
Most people recover well and see major improvements in smile symmetry and muscle control. Complications are usually mild and manageable, especially with good follow-up care.
In studies on selective neurectomy:
- Many people showedbetter facial symmetryandimproved muscle control.
- Most reported a higher quality of lifeand more natural-looking expressions.
- Some neededless BOTOX® after surgery.
By UPMC Editorial Staff. Last reviewed on 2026-03-01.
