{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T23:34:19Z","timestamp":1780616059208,"version":"3.54.1"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T00:00:00Z","timestamp":1765756800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005688","name":"Gottfried & Julia Bangerter-Rhyner-Stiftung","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005688","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Facial palsy affects millions worldwide. Botulinum toxin Type A (BoNT-A) is an established treatment for non-flaccid facial palsy, yet objective evidence remains limited. This study evaluates the effects of BoNT-A using AI-based tools and patient-reported outcome measures (PROMs). In this prospective observational study, patients with non-flaccid facial palsy received individualized BoNT-A injections. Exclusion criteria included age &lt; 18, hypersensitivity to BoNT-A, or lack of follow-up. Assessments were conducted before and 3 weeks after treatment, including facial symmetry (Emotrics\u00ae), emotion expression (FaceReader\u2122), and PROMs (FaCE and FDI). Eleven patients (mean age 50.1 \u00b1 18 years) were included. BoNT-A significantly improved dynamic facial symmetry: eyebrow raising (p = 0.032), smile angle (p = 0.005), and lower lip height (p = 0.042). Emotion analysis showed no significant changes. PROMs revealed improvements in social well-being (FDI, p = 0.004) and aesthetic satisfaction (FaCE, p = 0.035), while functional FDI scores remained unchanged (p = 0.406). BoNT-A improves objective symmetry and patient satisfaction in non-flaccid facial palsy. The lack of change in emotional expression may reflect improved symmetry at the cost of dynamic muscle activation.<\/jats:p>","DOI":"10.3390\/toxins17120597","type":"journal-article","created":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T15:52:59Z","timestamp":1765813979000},"page":"597","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Artificial Intelligence Analysis of Symmetry and Emotions in Facial Palsy Patients After Botulinum Toxin A Injections"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-5531-1316","authenticated-orcid":false,"given":"Seraina L. C.","family":"M\u00fcller","sequence":"first","affiliation":[{"name":"Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Zeier","sequence":"additional","affiliation":[{"name":"Medical University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Pfister","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadia","family":"Menzi","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bita","family":"Tafrishi","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"Schaefer","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan A.","family":"Plock","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tarek","family":"Ismail","sequence":"additional","affiliation":[{"name":"Department of Plastic, Reconstructive, Aesthetic, and Hand Surgery, University Hospital Basel, 4031 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holger J.","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery and Hand Surgery, Cantonal Hospital Aarau, 5001 Aarau, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E283","DOI":"10.1002\/lary.24542","article-title":"Etiology, diagnosis, and management of facial palsy: 2000 patients at a facial nerve center","volume":"124","author":"Hohman","year":"2014","journal-title":"Laryngoscope"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.bjps.2023.10.102","article-title":"Clinical features, evaluation, and management of ophthalmic complications of facial paralysis: A review","volume":"87","author":"Moncaliano","year":"2023","journal-title":"J. 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