Brief Answer:
Trigeminal neuralgia should not cause facial sagginess

Detailed Answer:
Hello dear,
Thanks for being on HCM.I read your previous discussions with fellow neurologists,and I can understand that you are very anxious about your looks.Your straight forward question here relates facial sagginess due to trigeminal neuralgia,and both of them doesn't go together.
Trigeminal neuralgia is a syndrome menifesting as episodic electric shock like pains in which each epidode last for few seconds only.There is no fixed muscle weakness in trigeminal neuralgia ,so as to cause sagginess.Only residual clinical feature can be pain,which can sometimes be persistent,rather episodic,but that too happens when the frequency of episodes is too much ,something like 20-30 episodes in 3 hours.Moreover,trigeminal neuralgia is a remitting and relapsing kind of disease,which responds well to medicine like carbamazepine and patients usually have symptom free periods intermittently which can last for months, even.

Sagginess is caused by asymmetry in the tone ,bulk and strength of muscles of face or jaw,if we talk with regards to your case,but trigeminal neuralgia is a disease which doesn't affect the muscles at all.So,neither logically nor in the clinical practice,it goes like that.
Rather,Trigeminal neuropathy that too,trigeminal motor neuropathy(and not trigeminal sensory neuropathy as you said you were diagnosed) affecting jaw muscles like masseter and pterygoids can cause facial asymmetry or sagginess,but uncommonly.
Bell's palsy or facial palsy in the clinical practice is the most common cause of facial sagging or weakness.
Sometimes,rarely, bell's palsy occurs along with trigeminal neuropathy,and if that is the case,we can have clinical features overlapping for both.
It's good that your MRI Brain has turned normal so that you don't have a serious secondary condition lying within and we are dealing with all that is primary.
Whatever the cause,your facial asymmetry will significantly go away with a proper physiotherapy training for facial muscles.So,be reassured and don't get tensed.
Still,if you find like,you can send your images so that i can give you a better opinion.And in any case,if you like to follow up or have any further questions,you are most welcome.
Thanks

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Brief Answer:
It will significantly improve with proper physiotherapy

Detailed Answer:
Hi dear,
Thanks for being in follow up and sending the image.I saw the mild sagging you have.So far,as your brain MRI is normal,your primary diagnosis here whether it is trigeminal neuropathy(which it don't appear to be,rather a mild case of bell's palsy) or a facial palsy,will hardly affect the prognosis,if it is in a static course.

Please ensure physiotherapy of facial muscles with proper and technique and it will improve significantly or completely over a period of time,usually months.Amitriptyline will not help, unless you are having pain.So,you can stop it.

regards,

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Brief Answer:
It will improve, rest assured.. physiotherapy will help as well...

Detailed Answer:
Hi again,
I can sense that you are tremendously anxious over the issue.Micro-current therapy would have helped much if pain was a significant complaint of yours. Since,it is the weakness of muscles resulting in sagginess,a fixed deficit,it is for the natural course of the human body to heal it and it will take its time,provided the stimulus is provided to heal it.

Providing stimulus as I said here is the key,its like ,a child can't learn alphabets unless he is taught or trained for it.Similarly,your facial muscles will start behaving normally(due to the sprouting or regeneration of the damaged nerve) and will be back in shape,once you will start giving stimulus to it and facial exercises and eyelid exercises are that stimulus.

Micro current therapy would have caused much improvement, if it would have been something acute like 'pain'.

In addition,over the time you can take some drugs to promote nerve regeneration like methylcobalamin and continue amitriptyline if pain is severe.

'Reassurance' and 'physiotherapy' are your keywords here and everything will be fine,including your sensitive nerve.Believe in yourself.

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Brief Answer:
In a few months but with proper facial exercises only.

Detailed Answer:
Hello dear,
I am telling you on the basis of medical literature and my clinical experience that it will significantly or completely improve provided you do exercises.Keep out negative thoughts away.It may stay permanently if an individual want it to stay so(One who will not do facial exercises,it may stay).Be assured and have a will.

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Brief Answer:
Yes I received.To an expert physiotherapist.

Detailed Answer:
You are most welcome.Yes,I received it,saw it and all my comments are based after assessing you on that photo.You can seek an expert physiotherapist with good reputation,at a location near to you.Thanks.

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Brief Answer:
I said significantly or completely.

Detailed Answer:
I understand.You need a 100% assurance.But,from my end,I said significant or complete improvement.Figure wise-more than 95 percent people show complete recovery within 1 year.And these are scientific figures.I wish I could say 100%. But,I'm no God afterall.

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Brief Answer:
Please visit a dentist.

Detailed Answer:
Hi dear,
Every pain is not 'neuralgia'.'Neuralgia' means a pain whose origin is in a nerve.For your dental pain,please visit a dentist to exclude a dental pathology first.If dental examination is normal,please follow-up.I shall be glad to help you.Thank you too.

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Brief Answer:
Is it on the same side as your facial sagginess and sensitive nerve is?

Detailed Answer:
Is it on the same side as facial complaints or is it diffuse in all teeth or in some particular teeth?Is it persistent or intermittent?Are there any trigger factors like cold food,or touching or exposure to air?

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Brief Answer:
It is due to trigeminal neuropathy.

Detailed Answer:
Since the teeth are innervated by trigeminal nerve,in some patients trigeminal neuropathy can result in dental pain.

So,is the cause.You should have a trial of carbamazepine(sustained release) 200 mg twice a day along with methylcobalamin(of course under the guidance and prescription of your physician).It probably will, improve your symptoms.

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Brief Answer:
Yes

Detailed Answer:
Yes,that's the diagnosis.This combination is rare,but is known to occur.

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