REFINEMENT IN THE REHABILITATION OF THE PARALYZED FACE USING BOTULINUM TOXIN

A number of surgical procedures exist to improve facial symmetry for p atients with facial paralysis. Whereas static symmetry is often improv ed, dynamic asymmetry frequently persists because of the imbalance of complex coordinated movements of facial expression, The paralyzed face is often distorted by the excessive pull of the normal contralateral face during emotional expression, This study reports an expanded clini cal indication for botulinum toxin in patients with unilateral facial paralysis. Ten patients with facial paralysis and markedly asymmetric smiles were treated with botulinum toxin A injections into the contral ateral zygomaticus major, levators labii superioris and angulii oris, or risorius muscles. Eight of the 10 patients noted improvement in the symmetry of their smiles and underwent repeat injections. The onset a nd duration of effect averaged 5.9 days and 3 months, respectively, Bo tulinum toxin therapy provides a safe and efficacious modality for ref ining the appearance of the paralyzed face during mimetic activity.