Synkinesis Between Orbicularis Oculi and Procerus Muscles: 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. Ocularnasal synkinesis has been reported in two patients following cosmetic rhinoplasty. However, synkinesis between orbicularis oculi and procerus muscles has not been reported by now. Methods: Interventional case report. Results: Two women, aged 42 and 37 years, presented with unilateral contraction of medial eyebrow muscles (procerus) with spontaneous or voluntary blinking, four and five months after cosmetic rhinoplasty, respectively. Both were successfully treated with injection of botulinum toxin A. Conclusion: Surgical trauma is inevitable during every procedure, including rhinoplasty, and may damage the fine structures including branches of facial nerve innervating the muscles. Gentle tissue handling may minimize iatrogenic injury to the fine motor branches of 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.