middle third of the face. In palsy cases, one side of the face has
no active elevator muscles. Hence, it is even more important
to reduce platysma activity, in order to rebalance asymmetric
tissue descent.
CONCLUSIONS
Use of BoNTA across the whole face and neck is a minimally invasive approach to the aesthetic treatment of facial palsy with a low risk of major complications and the potential for excellent results. When treating these patients, it is essential to find a balance between the relaxing effects of BoNTA and preservation of residual motor function. If treatment is performed gradually by a skilled practitioner, an acceptable compromise between aesthetics and function can be achieved.
In the two cases described here, we have demonstrated marked improvements in synkinesis, hyperkinesis and facial symmetry, and also shown an anti-aging effect similar to that achieved with normal full-face treatments using BoNTA.8 Results stabilized across multiple sessions of repeat treatment.
In the two cases described here, we have demonstrated marked improvements in synkinesis, hyperkinesis and facial symmetry, and also shown an anti-aging effect similar to that achieved with normal full-face treatments using BoNTA.8 Results stabilized across multiple sessions of repeat treatment.
DISCLOSURES
The authors declare no potential conflicts of interest with respect
to the research, authorship, and publication of this article.
ACKNOWLEDGMENT
Writing and editorial assistance was provided to the authors by
Timothy Ryder, DPhil, of Biological Communications Limited
(London, United Kingdom) and funded by Allergan plc (now
AbbVie) at the request of the investigator.
REFERENCES
1. Cooper L, Lui M, Nduka C. Botulinum toxin treatment for facial palsy: systematic review. J Plast Reconstr Aesthet Surg. 2017;70:833-841.
2. Cabin JA, Massry GG, Azizzadeh B. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg. 2015;23:272-280.
3. Serrera-Figallo MA, Ruiz-de-León-Hernández G, Torres-Lagares D, et al. Use of botulinum toxin in orofacial clinical practice. Toxins. 2020;12:112.
4. Thomas AJ, Larson MO, Braden S, Cannon RB, Ward PD. Effect of 3 commercially available botulinum toxin neuromodulators on facial synkinesis: A randomized clinical trial. JAMA Facial Plast Surg. 2018;20:141-147.
5. Shinn JR, Nwabueze NN, Du L, et al. Treatment patterns and outcomes in botulinum therapy for patients with facial synkinesis. JAMA Facial Plast Surg. 2019;21:244-251.
6. Lapidus JB, Lu JC, Santosa KB, et al. Too much or too little? A systematic review of postparetic synkinesis treatment. J Plast Reconstr Aesthet Surg. 2020;73:443-452.
7. Mehdizadeh OB, Diels J, White WM. Botulinum toxin in the treatment of facial paralysis. Facial Plast Surg Clin North Am. 2016;24:11-20.
8. D'Emilio R, Rosati G. Full-face treatment with onabotulinumtoxinA: Results from a single-center study. J Cosmet Dermatol. 2020;19:809-816.
9. Neville C, Venables V, Aslet M, Nduka C, Kannan R. An objective assessment of botulinum toxin type A injection in the treatment of postfacial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire. J Plast Reconstr Aesthet Surg. 2017;70:1624-1628.
2. Cabin JA, Massry GG, Azizzadeh B. Botulinum toxin in the management of facial paralysis. Curr Opin Otolaryngol Head Neck Surg. 2015;23:272-280.
3. Serrera-Figallo MA, Ruiz-de-León-Hernández G, Torres-Lagares D, et al. Use of botulinum toxin in orofacial clinical practice. Toxins. 2020;12:112.
4. Thomas AJ, Larson MO, Braden S, Cannon RB, Ward PD. Effect of 3 commercially available botulinum toxin neuromodulators on facial synkinesis: A randomized clinical trial. JAMA Facial Plast Surg. 2018;20:141-147.
5. Shinn JR, Nwabueze NN, Du L, et al. Treatment patterns and outcomes in botulinum therapy for patients with facial synkinesis. JAMA Facial Plast Surg. 2019;21:244-251.
6. Lapidus JB, Lu JC, Santosa KB, et al. Too much or too little? A systematic review of postparetic synkinesis treatment. J Plast Reconstr Aesthet Surg. 2020;73:443-452.
7. Mehdizadeh OB, Diels J, White WM. Botulinum toxin in the treatment of facial paralysis. Facial Plast Surg Clin North Am. 2016;24:11-20.
8. D'Emilio R, Rosati G. Full-face treatment with onabotulinumtoxinA: Results from a single-center study. J Cosmet Dermatol. 2020;19:809-816.
9. Neville C, Venables V, Aslet M, Nduka C, Kannan R. An objective assessment of botulinum toxin type A injection in the treatment of postfacial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire. J Plast Reconstr Aesthet Surg. 2017;70:1624-1628.
AUTHOR CORRESPONDENCE
Roberta D'Emilio MD demilioroberta@gmail.com
