{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T16:51:19Z","timestamp":1784566279652,"version":"3.55.0"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T00:00:00Z","timestamp":1628553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,2,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Facial nerve injury after facelift is rare; hence, its treatment is poorly established. Botulinum toxin type A (BTXA) can be employed to resolve the asymmetry. To our knowledge, there is no protocol in the literature about the best timing for this treatment, injection sites, or recommended dose.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The authors sought to propose a protocol to guide the management of asymmetries post-facelift.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Fifteen patients with post-rhytidectomy facial palsies were treated in the non-paralyzed side with BTXA. After analysis of the smile deviation vectors, it is possible to identify the muscles that should be treated. The dose varied from 1 to 2 volume-unit per point. Patients were examined after 15 days for outcomes evaluation and touch-up if needed. Patients were re-treated after 5 to 6 months in case of asymmetry recurrence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Symmetry was achieved in all cases. Six patients had definitive nerve lesions and required treatment every 6 months after the first session. Five patients had lesions affecting the upper third of the face; 4 of them were definitive nerve lesions. Two of the 4 patients who were treated less than 2 weeks after surgery recovered early from the post-facelift paralysis and developed reversed asymmetry due to the BTXA. In 7 patients, the post-facelift asymmetry was due to neuropraxis: the recovery from the nerve injury and BTXA treatment occurred symmetrically on both sides of the face in the following months after 1 single session.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Asymmetries post-facelift were successfully managed with the proposed protocol. The best time for injection was 2 to 4 weeks after surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Level of Evidence: 4<\/jats:title>\n                  <jats:p\/>\n               <\/jats:sec>","DOI":"10.1093\/asj\/sjab311","type":"journal-article","created":{"date-parts":[[2021,8,10]],"date-time":"2021-08-10T07:44:10Z","timestamp":1628581450000},"page":"NP144-NP150","source":"Crossref","is-referenced-by-count":8,"title":["Management of Post-Facelift Facial Paralysis With Botulinum Toxin Type A"],"prefix":"10.1093","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5053-4305","authenticated-orcid":false,"given":"Alessandra Grassi","family":"Salles","sequence":"first","affiliation":[{"name":"Division of Plastic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wellington Menezes","family":"Mota","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adelina F\u00e1tima do Nascimento","family":"Remigio","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Carlos Herrmann","family":"de Andrade","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Gemperli","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery, Hospital das Cl\u00ednicas da Faculdade de Medicina da Universidade de S\u00e3o Paulo , S\u00e3o Paulo , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,8,10]]},"reference":[{"issue":"4","key":"2023010807402440100_CIT0001","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1007\/s00266-009-9337-9","article-title":"Botulinum toxin injection in long-standing facial paralysis patients: improvement of facial symmetry observed up to 6 months","volume":"33","author":"Salles","year":"2009","journal-title":"Aesthetic Plast Surg"},{"issue":"5","key":"2023010807402440100_CIT0002","doi-asserted-by":"crossref","first-page":"1185","DOI":"10.1097\/00006534-200010000-00033","article-title":"National Plastic Surgery Survey: face lift techniques and complications","volume":"106","author":"Matarasso","year":"2000","journal-title":"Plast Reconstr Surg"},{"issue":"6","key":"2023010807402440100_CIT0003","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1097\/00006534-197912000-00005","article-title":"Avoiding facial nerve injuries in rhytidectomy. 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