CC BY-NC-ND 4.0 · Indian J Plast Surg 2020; 53(02): 219-229
DOI: 10.1055/s-0040-1715189
Review Article

The Treatment of Facial Asymmetry with Botulinum Toxin: Current Concepts, Guidelines, and Future Trends

Izolda Heydenrych
1  Department of Dermatology, Cape Town Cosmetic Dermatology Centre, Central Park on Esplanade, Century City, Cape Town, South Africa
› Author Affiliations


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.

Publication History

Publication Date:
29 August 2020 (online)

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