Facial nerve injury due to Lyme disease

For those of you who read this blog regularly, you will be familiar with my tribulations and fallen face. I thought initially that the acute facial paralysis I developed one morning upon awakening was due to a condition called Bell’s palsy. See below for more information on the facial nerve and its injury.

Facelift and facial nerve injury

Facial nerve injury without facelift

A few days after writing that post, I saw that I had developed a strange oval-shaped rash on my belly. Facial nerve paralysis + rash + living in the northeastern United States = Lyme disease. I am under treatment with antibiotics now.

The facial palsy has improved, though slowly. Here are my photos at a month’s difference. You can compare them with what I looked like in the earlier post above.

1 month post paralysis at restpost paralysis at rest

smiling after paralysis

The most annoying part of this ordeal has not been the disfigurement; after all, as a cosmetic plastic surgeon, I am hard-wired for dealing with that. Rather, the annoyances have been a tearing up from my right eye, which cannot close properly and is prone to tearing. That is very annoying.

Also, the loss of taste on one half of my tongue is much more of a handicap than I would have thought. I am no glutton, but loss of taste means there is no enjoyment in eating. I have forgone my second helpings and just eat less because it’s no fun; I have lost 13 pounds, though some of that may be due to the Lyme disease.

Lyme disease

Lyme disease is a tick-borne infection common in the northeastern US. The tick is carried around by deer and jumps onto plants and then onto humans who brush against a blade of grass or a plant. The tick bites us and we become infected by a form of bacteria the tick carries, which leads to infection.

Lyme disease shows many varied symptoms and the diagnosis is sometimes difficult.

  • A tell-tale “bulls eye rash” may or may not be present ( I had just a big red rash)
  • Fatigue
  • Runny nose
  • Muscle and joint pain
  • Headaches
  • Acute facial paralysis

These are some of the symptoms of Lyme disease.

A diagnosis is confirmed by drawing a blood test for the body’s reaction to the bacteria; it often comes back equivocal.

Treatment is with a 3-6 week course of antibiotics, typically Doxycyclin. Recently, a new form of “Lyme” has been identified that is caused by a different bacteria that is not sensitive to Doxycyclin. As for my facial palsy, it will hopefully get better by itself in the next few weeks. There is little to do but treat the Lyme disease and wait for the facial nerve to come back. I exercise the muscles daily to keep them from atrophying.

No treatment can lead to debilitating conditions that essentially make the patient bed-ridden.

The rule is: if you suspect you have Lyme, see a doctor and get treated.

Morad Tavallali, M.D., FACS