{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:45:42Z","timestamp":1792172742754,"version":"4.4.0"},"reference-count":30,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2020,8,29]],"date-time":"2020-08-29T00:00:00Z","timestamp":1598659200000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Indian J Plast Surg"],"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This article will describe facial asymmetry secondary to facial nerve paralysis (FNP), and review current concepts, guidelines, and future trends. Despite the increasing use of botulinum toxin (BoNTA) in treating FNP, ideal dosage, timing, and additional therapies are not unequivocally established. Facial asymmetry significantly impacts quality of life (QOL) by strongly affecting self-perception and social interactions; injectables may mediate great clinical improvement. This article provides practical guidelines for the use of BoNTA and provides schemes for accurate assessment and documentation. A systematic, stepwise approach is recommended with methodical assessment, meticulous placement, conservative dosage, and careful follow-up. Future trends include the potential use of newly developed toxins, muscle modification with fillers, improved imaging techniques, and targeted QOL studies. Hopefully, a growing number of aesthetic injectors may become technically proficient and join multidisciplinary teams for managing FNP.<\/jats:p>","DOI":"10.1055\/s-0040-1715189","type":"journal-article","created":{"date-parts":[[2020,8,29]],"date-time":"2020-08-29T22:30:47Z","timestamp":1598740247000},"page":"219-229","source":"Crossref","is-referenced-by-count":23,"title":["The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends"],"prefix":"10.1055","volume":"53","author":[{"given":"Izolda","family":"Heydenrych","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South  Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,8,29]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jobcr.2017.04.010","article-title":"Facial asymmetry revisited: Part I- diagnosis and treatment planning","volume":"8","author":"D Srivastava","year":"2018","journal-title":"J Oral Biol Craniofac Res"},{"issue":"06","key":"ref2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.bjps.2017.01.009","article-title":"Botulinum toxin treatment for facial palsy: a \u00a0systematic review","volume":"70","author":"L Cooper","year":"2017","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1186\/s12955-018-1038-0","article-title":"The association between paralytic side and health-related quality of life in facial palsy: a cross-sectional study of the Korea National Health and Nutrition Examination Survey (2008-2012)","volume":"16","author":"S Kim","year":"2018","journal-title":"Health Qual Life Outcomes"},{"issue":"12","key":"ref4","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1136\/jnnp-2014-309563","article-title":"Bell\u2019s palsy: aetiology, clinical features and multidisciplinary care","volume":"86","author":"T J Eviston","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref5","doi-asserted-by":"crossref","DOI":"10.1201\/9781315146690","volume-title":"Aesthetic Facial Anatomy Essentials for Injections","author":"A Pirayesh","year":"2020"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.fsc.2015.09.008","article-title":"Botulinum toxin in the treatment of facial paralysis","volume":"24","author":"O B Mehdizadeh","year":"2016","journal-title":"Facial Plast Surg Clin North Am"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1002\/lary.27481","article-title":"Facial palsy-specific quality of life in 920 patients: correlation with clinician-graded severity and predicting factors","volume":"129","author":"J Tavares-Brito","year":"2019","journal-title":"Laryngoscope"},{"issue":"02","key":"ref8","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MAO.0b013e31827c9f58","article-title":"Contralateral botulinum toxin injection to improve facial asymmetry after acute facial paralysis","volume":"34","author":"J Kim","year":"2013","journal-title":"Otol Neurotol"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-019-09282-4","article-title":"The etiology of Bell\u2019s palsy: a review","author":"W Zhang","year":"2019","journal-title":"J Neurol"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1055\/s-2002-32200","article-title":"Outcomes with eye reanimation microsurgery","volume":"18","author":"J K Terzis","year":"2002","journal-title":"Facial Plast Surg"},{"issue":"07","key":"ref11","doi-asserted-by":"crossref","first-page":"1905","DOI":"10.1097\/00006534-199706000-00016","article-title":"Analysis of 100 cases of free-muscle transplantation for facial paralysis","volume":"99","author":"J K Terzis","year":"1997","journal-title":"Plast Reconstr Surg"},{"issue":"05","key":"ref12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1001\/jamafacial.2016.0533","article-title":"Association of eyelid position and facial nerve palsy with unresolved weakness","volume":"18","author":"K R Sinha","year":"2016","journal-title":"JAMA Facial Plast Surg"},{"issue":"06","key":"ref13","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1136\/bjophthalmol-2017-310525","article-title":"Non-aesthetic indications for periocular hyaluronic acid filler treatment: a review","volume":"102","author":"P Tan","year":"2018","journal-title":"Br J Ophthalmol"},{"issue":"02","key":"ref14","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/019459988509300202","article-title":"Facial nerve grading system","volume":"93","author":"J W House","year":"1985","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/S0194-5998(96)70206-1","article-title":"Development of a sensitive clinical facial grading system","volume":"114","author":"B G Ross","year":"1996","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"02","key":"ref16","doi-asserted-by":"crossref","first-page":"223e","DOI":"10.1097\/PRS.0000000000001447","article-title":"Clinician-graded electronic facial paralysis assessment: The eFACE","volume":"136","author":"C A Banks","year":"2015","journal-title":"Plast Reconstr Surg"},{"issue":"06","key":"ref17","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.otc.2018.07.011","article-title":"Facial rehabilitation: evaluation and treatment strategies for\u00a0the\u00a0patient with facial palsy","volume":"51","author":"M W Robinson","year":"2018","journal-title":"Otolaryngol Clin North Am"},{"issue":"08","key":"ref18","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1016\/j.bjps.2013.04.012","article-title":"Botulinum toxin injection of both sides of the face to treat post-paralytic facial synkinesis","volume":"66","author":"K H Choi","year":"2013","journal-title":"J Plast Reconstr Aesthet Surg"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"925e","DOI":"10.1097\/PRS.0b013e318230e758","article-title":"Therapeutic strategies in post-facial paralysis synkinesis in adult patients","volume":"129","author":"J K Terzis","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref20","first-page":"383","article-title":"The \u201cGate Keeper\u201d: a case study in the selection of news","volume":"27","author":"D M White","year":"1950","journal-title":"Journal Bull"},{"issue":"09","key":"ref21","first-page":"1","article-title":"Effective botulinum toxin injection guide for treatment of temporal headache","volume":"8","author":"Y J Choi","year":"2016","journal-title":"Toxins (Basel)"},{"issue":"04","key":"ref22","first-page":"341","article-title":"Facial asymmetry: etiology, evaluation, and management","volume":"34","author":"Y W Cheong","year":"2011","journal-title":"Chang Gung Med J"},{"issue":"05","key":"ref23","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/MLG.0b013e3180412460","article-title":"Validation of the synkinesis assessment questionnaire","volume":"117","author":"R P Mehta","year":"2007","journal-title":"Laryngoscope"},{"issue":"05","key":"ref24","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1097\/ICU.0000000000000503","article-title":"Physical therapy for facial nerve palsy: applications for the physician","volume":"29","author":"L andingham van SW","year":"2018","journal-title":"Curr Opin Ophthalmol"},{"issue":"11","key":"ref25","doi-asserted-by":"crossref","first-page":"603","DOI":"10.2147\/CCID.S180904","article-title":"A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures and algorithms for management","volume":"11","author":"I Heydenrych","year":"2018","journal-title":"Clin Cosmet Investig Dermatol"},{"issue":"03","key":"ref26","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1007\/s00266-018-1116-z","article-title":"Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement","volume":"42","author":"M de Maio","year":"2018","journal-title":"Aesthetic Plast Surg"},{"key":"ref27","doi-asserted-by":"crossref","DOI":"10.1201\/9781315146690-14","volume-title":"Myomodulation","author":"M De Maio","year":"2020"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1097\/00005537-200103000-00005","article-title":"Validation of a patient-graded instrument for facial nerve paralysis: the FaCE scale","volume":"111","author":"J B Kahn","year":"2001","journal-title":"Laryngoscope"},{"key":"ref29","first-page":"92","article-title":"Botulinumtoxin-A und dermale Gewebefiller in der fazialen rehabilitation","volume":"167","author":"U Wollina","year":"2017","journal-title":"Wien Med Wochenschr"},{"issue":"01","key":"ref30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.bjoms.2017.11.015","article-title":"Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures","volume":"56","author":"C Sforza","year":"2018","journal-title":"Br J Oral Maxillofac Surg"}],"container-title":["Indian Journal of Plastic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/s-0040-1715189.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T23:40:32Z","timestamp":1598917232000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/s-0040-1715189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":30,"journal-issue":{"issue":"02","published-online":{"date-parts":[[2020,8,31]]},"published-print":{"date-parts":[[2020,8]]}},"URL":"https:\/\/doi.org\/10.1055\/s-0040-1715189","relation":{},"ISSN":["0970-0358","1998-376X"],"issn-type":[{"value":"0970-0358","type":"print"},{"value":"1998-376X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]}}}