Non-surgical treatments in facial paralysis sequelae: a critical review of the literature and clinical recommendations

Zavala A.; de Pawlikowski W. · Cirugia Plastica Ibero-Latinoamericana (2024) · DOI: 10.4321/s0376-78922024000400008

Resumen

Background and objective. The sequelae of facial paralysis, such as synkinesis, asymmetry, and hyperkinesis, significantly affect facial expression and mobility leading to a substantial impact on quality of life. This article provides a critical review of non-surgical treatments available for managing these sequelae, offering clinical recommendations based on current evidence and the authors' expertise. Methods. A selective review of the literature in English and Spanish was conducted using databases such as PubMed, Scopus, TripDatabase, and SciELO. Studies focusing on neuromuscular retraining, botulinum toxin, and facial fillers for the treatment of facial paralysis sequelae were included. A total of 39 relevant articles published between 1982 and 2024 along with 3 additional texts on the pathophysiology and management of facial paralysis, were analyzed to assess the efficacy and safety of non-surgical treatments. Results. Neuromuscular retraining has been shown to effectively reduce synkinesis and improve facial motility. Botulinum toxin yields positive outcomes in decreasing abnormal contractions and enhancing both aesthetic appearance and facial function, especially when combined with retraining. Facial fillers are also effective in correcting asymmetry and unilateral volume loss. Conclusions. Non-surgical treatments, such as neuromuscular retraining, botulinum toxin, and facial fillers, represent effective options for the treatment of facial paralysis sequelae. A personalized approach, considering both facial anatomy and underlying pathophysiology, is essential for optimizing outcomes in these minimally invasive procedures.