The essential role of Aesthetic Medicine in facial paralysis: combination of techniques

Main Article Content

Ricardo Moutinho-Guilherme https://orcid.org/0000-0001-6272-7684
López Juan

Keywords

Botulinum toxins, Esthetics, Facial asymmetry, Facial nerve injuries, Facial paralysis, Hyaluronic acid

Abstract

The face is the first point of contact in communication interactions; it reveals the person’s feelings and emotions. Injuries caused to the facial nerve, which is responsible for the innervation of the facial mimic muscles, can have important physical, psychological and even social repercussions. Bell’s palsy or idiopathic peripheral facial paralysis is the most common cause and is characterized by unilateral paralysis of the muscles, producing a clear pattern of asymmetric facial expressions. Patients with facial paralysis have common features: the paralyzed side has few wrinkles, the nasolabial fold is less evident, and drooping of the labial commissure and eyebrow may occur; the contralateral side responds with a muscle hyperkinetic reaction. The treatment of facial paralysis aims to recover symmetry in both static and dynamic states, with the combination of surgical and aesthetic methods playing an essential role in the treatment of this pathology. In the search for local symmetry, Aesthetic Medicine plays an important part, by using different methods, such as botulinum toxin injections or hyaluronic acid fillers application. In this sense, this article aims to present a case of a woman affected by facial paralysis, in whom Aesthetic Medicine played an essential role in self-esteem and functional recovery. With clinical improvement, softening asymmetries and reducing hyperkinetic muscle activity proved to have an essential impact in this patient’s facial asymmetry, promoting a considerable enhancement in quality of life and social well-being.

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References

1. de Maio M, Soares M. Toxina botulínica em paralisia facial: um tratamento minimamente invasivo para redução de hipercinesia muscular da região perioral contralateral. Arq Int Otorrinolaringol. 2007; 11: 28-35.
2. Bento RF, Brito RV. Gunshot wounds to the facial nerve. Otol Neurotol. 2004; 25 (6): 1009-71.
3. de Sanctis Pecora C, Shitara D. Botulinum toxin type A to improve facial symmetry in facial palsy: a practical guideline and clinical experience. Toxins. 2021; 13: 159.
4. Sadiq SA, Khwaja S, Saeed SR. Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Eye. 2012; 26: 1431-6.
5. Macgregor FC. Facial disfigurement: problems and management of social interaction and implications for mental health. Aesthet Plast Surg. 1990; 14: 249-57.
6. de Carvalho VF, Vieira APS, Paggiaro AO, Salles AG, Gemperli R. Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin. Int J Dermatol. 2019; 58: 1175-83.
7. de Maio M. Use of botulinum toxin in facial paralysis. J Cosmet Laser Ther. 2003; 5: 216-7.
8. Ueda K, Hari K, Asato H, Yoshimura K, Yamada A. Evaluation of muscle graft using facial nerve on the affected side as a motor source in the treatment of facial paralysis. Scand J Plast Reconstr Surg Hand Surg. 1999; 33 (1): 47-57.
9. Terzis JK, Kalantarian B. Microsurgical strategies in 74 patients for restoration of dynamic depressor muscle mechanism: a neglected target in facial reanimation. Plast Reconstr Surg. 2000; 105 (6): 1917-31.
10. Kermer C, Millesi W, Paternostro T, Nuhr M. Muscle-nerve-muscle neuronization of the orbicularis oris muscle. J Craniomaxillofac Surg. 2011; 29 (5): 302-6.
11. Bento RF, Almeida ER, Miniti A. Anastomosis of intratemporal facial nerve with fibrin tissue adhesive. Eur Arch Otorynolaringol. 1994: S387-8.
12. Benardes DFF, Gomez MVS, Pirana S, Bento RF. Functional profile in patients with facial paralysis treated in a myofunctional approach. Pro Fono. 2004; 16: 151.
13. Choo PH, Carter SR, Seiff SR. Upper eyelid gold weight implantation in the Asian patient with facial paralysis. Plast Reconstr Surg. 2000; 105: 855-9.
14. Adant JP. Endoscopically assisted suspension in facial palsy. Plast Reconstr Surg. 1998; 102 (1): 178-81.
15. Shumrick KA, Pensak ML. Early perioperative use of polytef suspension for the management of facial paralysis after extirpative skull base surgery. Arch Facial Plast Surg. 2000; 2 (4): 243-8.
16. Frevert J. Pharmaceutical, biological, and clinical properties of botulinum neurotoxin type A products. Drugs R D. 2015; 15: 1-9.
17. Pierre S, Liew S, Bernardin A. Basics of dermal filler rheology. Dermatol Surg. 2015; 41: S120-6.
18. Finn JC. Botulinum toxin type A: fine-tuning treatment of facial nerve injury. J Drugs Dermatol. 2004; 3 (2): 133-7.
19. Bulstrode NW, Harrison DH. The phenomenon of the late recovered Bell’s palsy: treatment options to improve facial symmetry. Plast Reconstr Surg. 2005; 115 (6): 1466-71.
20. Krohel GB, Cipollo CL, Gaddipati K. Contralateral botulinum injections improve drinking ability and facial symmetry in patients with paralysis. Am J Ophtalmol. 2005; 139 (3): 540.
21. Blitzer A, Sulica L. Botulinum toxin: basic science and clinical uses in otolaryngology. Laryngoscope. 2001; 111: 218-26.
22. Neunschwander MC, Pribitkin EA, Staloff RT. Botulinum toxin in otoryngology: a review of its actions and opportunity for use. Ear Nose Throat J. 2000; 79 (10): 788-9.
23. Wang A, Jankovic J. Hemifacial spasm: clinical findings and treatment. Muscle Neve. 1998; 21 (12): 1740-7.
24. Carruthers A, Carruthers J. Botulinum toxin type A: history and current cosmetic use in the upper face. Semin Cutan Med Surg. 2001; 20 (2): 71-84.
25. Armstrong MW, Mountain RE, Murray JA. Treatment of facial synkinesis and facial asymmetry with botulinum toxin type A following facial nerve palsy. Clin Otolaryngol. 1996; 21 (1): 15-20.
26. Kim J. Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis. Otol Neurotol. 2013; 34: 319-24.
27. Occhiogrosso J, Derakhshan A, Hadlock TA, Shanley KM, Lee LN. Dermal filler treatment improves psychosocial well-being in facial paralysis patients. Facial Plast Surg Aesthet Med. 2020; 22: 5.
28. Fu L, Bundy C, Sadiq SA. Psychological distress in people with disfigurement from facial palsy. Eye. 2011; 25: 1322-6.
29. de Maio M, Bento RF. Botulinum toxin in facial palsy: an effective treatment for contralateral hyperkinesis. Plast Reconstr Surg. 2007; 120: 917-27.
30. Miller MQ, Hadlock TA. Beyond botox: contemporary management of nonflaccid facial palsy. Facial Plast Surg Aesthet Med. 2020; 22: 65-70.