The use of botulinum toxin in the treatment of peripheral facial palsy




Facial Palsy; Botulinum Toxin; Symmetry; Asymmetry.


Peripheral Facial Palsy (PFP) is a state of paralysis or weakening of the facial muscles that causes motor and aesthetic limitations to the patient with this condition. One means of treatment for PFP that is gaining prominence is the use of botulinum toxin on the side contralateral to that affected by the condition. This toxin is collected from the spores of the bacterium Clostridium botulinum, and its action inhibits the release of acetylcholine at the neuromuscular junction, reducing muscle hyperfunction and restoring symmetry to the patient's face. Therefore, this study aims to achieve the knowledge of the best protocol for the application of the toxin in paralysis, as well as which serotype to use and the ability to improve the patient's quality of life. The study consists of a basic, qualitative, descriptive-exploratory integrative review based on the main research platforms searching for the terms facial paralysis and botulinum toxin. Articles were included from 2011 to 2021 in the English language and the search resulted in 17 articles. In all reviewed articles the botulinum toxin serotype A was the only one used for the treatment, the amount of biological units (BIU) and the protocol was individualized for each patient exempting from a standard. The quality of life of the patients was restored after an improvement in facial symmetry was obtained and, with this, an increase in self-esteem, besides, mainly, restoring the ability to perform coordinated muscular actions. Therefore, it can be concluded that the treatment of PFP with botulinum toxin is highly beneficial to patients.


Akulov, M. A., Orlova, O. R., Orlova, A. S., Usachev, D. J., Shimansky, V. N., Tanjashin, S. V., Khatkova, S. E. & Yunosha- Shanyavskaya, A. V. (2017). IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery. Journal of the Neurological Sciences, (381), 130-134.

Alipour, S., Pick, C., Jansen, S. Rink, S. Klubmann, J. P., & Grosheva, M. (2021). Long-term therapy with botulinum toxin in facial synkinesis: Retrospective data analysis of data from 1998 to 2018. Clinical Otolaryngology published by John Wiley & Sons Ltd., 00:1–9.

Atolini Junior, N.,Jorge Junior, J. J., Gignon, V. F., Kitice, A. T., Prado, L. S. A. & Santos, V. G. W. (2009). Paralisia Facial Periférica: Incidência das Várias Etiologias num Ambulatório de Atendimento Terciário. Arq. Int. Otorrinolaringol., 13(2), 167-171.

Barbosa, D. B. M. & Brito, A. S. (2020). A utilização da toxina botulínica tipo a para alcançar a estética facial. Revista Terra & Cultura: Cadernos de Ensino e Pesquisa, 36(70),75-86.

Batista, K. T. (2011). Paralisia facial: análise epidemiológica em hospital de reabilitação. Rev. Bras. Cir. Plást., 26(4), 591-595.

Bennis, Y., Duquennoy-Martinot, V. & Guerresch, P. (2016). Epidemiologic Overview of Synkinesis in 353 Patients with Longstanding Facial Paralysis under Treatment with Botulinum Toxin for 11 years. American Society of Plastic Surgeons.

Cabin, J. A., Massry, G. G. & Azizzadeh, B. (2015). Botulinum toxin in the management of facial paralysis, Current Opinion in Otolaryngology & Head and Neck Surgery, 23(4), 272-280.

Carvalho, V. F., Vieira, A. P. S., Paggiaro, A. O., Salles, A. G & Gemperli, R. (2019). Evaluation of the body image of patients with facial palsy before and after the application of botulinum toxin. International Journal of Dermatology, 58(10), 1175-1183,

Choi, K. H., Rho, S. H., Lee, J. M., Jeon, J. H., Park S. Y. & Kim, J. (2013). Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 66, 1058-1063.

Colhado, O. C. G., Boeing, M. & Ortega, L. B. (2009). Toxina Botulínica no Tratamento da Dor. Revista Brasileira de Anestesiologia, 59(3), 366-381.

Díaz-Aristizabal, U., Valdés-Vilches, M., Fernández-Ferreras, T. R., Calero-Muñoz, E., Bienzobas-Allué, E., Aguilera-Ballester, L., & Carnicer-Cáceres, J. (2021). Effect of botulinum toxin typeA in functionality, synkinesis and quality of life in peripheral facial palsy sequelae. Efecto de la toxina botulínica tipoA en la funcionalidad, las sincinesias y la calidad de vida en secuelas de parálisis facial periférica. Neurologia (Barcelona, Spain), S0213-4853(21)00032-3.

Dobie, R. A. & Fisch, U. (1986). Primary and revision surgery (selective neurectomy) for facial hyperkinesia. Arch Otorynolaringol Head Neck Surg., 112(2), 154-163.

Dressler, D., Saberi, F. A. & Barbosa, E. R. (2005). Botulinum toxin: mechanisms of action. Arq. Neuro-Psiquiatr., 63(1), 180-185.

Estrela, C. (2018). Metodologia Científica: Ciência, Ensino, Pesquisa. Editora Artes Médicas.

Fonseca, K. M. O., Mourão, A. M., Motta, A. R. & Vicente, L. C. C. (2015). Scales of degree of facial paralysis: analysis of agreement. Braz. j. otorhinolaryngol., 81(3), 288-293.

Heyndenrych, I. (2020). The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends. Indian Journal of Plastic Surgery, 53(2), 219–229.

Kim, J. (2013). Contralateral Botulinum Toxin Injection to Improve Facial Asymmetry After Acute Facial Paralysis. Otology & Neurotology, 34, 319-324.

Lee, J. M., Choi, K. H., Lim, B. W., Kim, M. W. & Kim, J. (2015). Half-mirror biofeedback exercise in combination with three botulinum toxin A injections for long-lasting treatment of facial sequelae after facial paralysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 68, 71-78.

Maio, M. & Soares, M. F. D. (2007). Toxina Botulínica em Paralisia Facial: um Tratamento Miminamente Invasivo para Redução da Hipercinesia Muscular da Região Perioral Contralateral. Arq. Int. Otorrinolaringol., 11(1), 28-35.

Mandrini, S., Comelli, M., Dall’angelo, A., Togni, R., Cecini, M., Pavese, C. & Toffola, E.D. (2016). Long-term facial improvement after repeated BoNT-A injections and mirror biofeedback exercises for chronic facial synkinesis: a case-series study. European Journal of Physical and Rehabilitation Medicine, 52(6), 810-818.

Neville, C., Venables, V., Aslet, M., Nduka, C. & Kannan, R. (2017). An objective assessment of Botulinum toxin type A injection in the treatment of post facial palsy synkinesis and hyperkinesis using the Synkinesis Assessment Questionnaire (SAQ). Journal of Plastic, Reconstructive & Aesthetic Surgery, 70(11), 1624-1628.

Pecora, C. S. & Shitara, D. (2021). Botulinum Toxin Type A to Improve Facial Symmetry in Facial Palsy: A Practical Guideline and Clinical Experience. Journal Toxins, 13, 159

Remígio, A. F. N., Salles, A. G., Faria, J. C. M. & Ferreira, M. C. (2013). Comparison of the Efficacy of OnabotulinumtoxinA and AbobotulinumtoxinA at the 1:3 Conversion Ratio for the Treatment of Asymmetry after Long-Term Facial Paralysis. Plastic and Reconstructive Surgery, 135(1), 239-249.

Ribeiro, I. N. S., Santos, A. C. O., Gonçalves, V. M. & Cruz, E. F. (2014). O Uso da Toxina Botulínica tipo A nas Rugas Dinâmicas do Terço Superior da Face. Revista da Universidade Ibirapuera. 7, 31-37.

Risoud, M., Aljudaibi, N., Duquennoy-Martinot, V. & Guerreschi, P. (2015). Long-term sequelae treatment of peripheral facial paralysis with botulinum toxin type A: Repartition and kinetics of doses used. Annales de chirurgie plastique esthétique.

Rodrigues, R. E. C., Ceccato, S. B., Rezende, C. E. B., Garcia, R. I. D., Costa, K. S., Campilongo, M. & Rapoport, P. B. (2002). Paralisia facial periférica: análise de 38 casos. Fundação ABC, 27(2).

Rutzen, I. M., Atkins, D. Q. & Motta, K. (2016). EMG Guided Botulinum Toxin Type A Injections for Functional Problems Associated to Congenital Facial Palsy: A Case Report. 261-262.

Sadiq, S. A., Khwaja, S. & Saeed, S. R. (2012). Botulinum toxin to improve lower facial symmetry in facial nerve palsy. Macmillan Publishers Limited, 26, 1431–1436.

Sahan, A. & Tamer, F. (2017). Restoring facial symmetry through non-surgical cosmetic procedures after permanent facial paralysis: a case report. Acta Dermatovenerol, 26, 41-42.

Shinn, J. R., Nwabueze, N. N., Du, L., Patel, P. N., Motamedi K. K., Norton, C., Ries, W. R. & Stephane S. J. (2019). Treatment Patterns and Outcomes in Botulinum Therapy for Patients With Facial Synkinesis. JAMA Facial Plast Surg. 21(3), 244-251.



How to Cite

ANDALÉCIO, M. M.; ANDRADE, R. S. de .; LIMA, L. C. S.; CARVALHO, T. de A.; SILVA, I. A. P. S. The use of botulinum toxin in the treatment of peripheral facial palsy. Research, Society and Development, [S. l.], v. 10, n. 9, p. e8510917935, 2021. DOI: 10.33448/rsd-v10i9.17935. Disponível em: Acesso em: 18 sep. 2021.



Health Sciences