Botulinum toxin treatment for facial palsy: A systematic review

J Plast Reconstr Aesthet Surg. 2017 Jun;70(6):833-841. doi: 10.1016/j.bjps.2017.01.009. Epub 2017 Feb 16.


Background: Facial palsy may be complicated by ipsilateral synkinesis or contralateral hyperkinesis. Botulinum toxin is increasingly used in the management of facial palsy; however, the optimum dose, treatment interval, adjunct therapy and performance as compared with alternative treatments have not been well established. This study aimed to systematically review the evidence for the use of botulinum toxin in facial palsy.

Method: The Cochrane central register of controlled trials (CENTRAL), MEDLINE(R) (1946 to September 2015) and Embase Classic + Embase (1947 to September 2015) were searched for randomised studies using botulinum toxin in facial palsy.

Results: Forty-seven studies were identified, and three included. Their physical and patient-reported outcomes are described, and observations and cautions are discussed.

Discussion: Facial asymmetry has a strong correlation to subjective domains such as impairment in social interaction and perception of self-image and appearance. Botulinum toxin injections represent a minimally invasive technique that is helpful in restoring facial symmetry at rest and during movement in chronic, and potentially acute, facial palsy. Botulinum toxin in combination with physical therapy may be particularly helpful. Currently, there is a paucity of data; areas for further research are suggested. A strong body of evidence may allow botulinum toxin treatment to be nationally standardised and recommended in the management of facial palsy.

Keywords: Botulinum toxin; Facial palsy; Neuromuscular retraining therapy; Synkinesis.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Botulinum Toxins / administration & dosage
  • Botulinum Toxins / adverse effects
  • Botulinum Toxins / therapeutic use*
  • Facial Asymmetry / drug therapy
  • Facial Paralysis / drug therapy*
  • Humans
  • Injections, Intramuscular
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / adverse effects
  • Neuromuscular Agents / therapeutic use*


  • Neuromuscular Agents
  • Botulinum Toxins