Review Article| Volume 31, ISSUE 1, P71-83, March 2023

Botulinum Toxin in Facial Reanimation

Map of the Facial Musculature and Dosage
  • Tracy VandeWater
    Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA
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  • Laura Hetzler
    Corresponding author.
    Department of Otolaryngology–Head & Neck Surgery, Louisiana State University Health Sciences Center, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA

    Center For Facial Nerve Disorders, Our Lady of The Lake Regional Medical Center, 4950 Essen Lane, Suite 402, Baton Rouge, LA 70809, USA
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        • Bellows S.
        • Jankovic J.
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        • Borodic G.E.
        • Pearce L.B.
        • Cheney M.
        • et al.
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        • Lohuis P.J.
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        • Celik M.
        • Forta H.
        • Vural C.
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        • Derakhshan A.
        • Miller M.Q.
        • Malka R.
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      1. Field Malgorzata, et al., AbobotulinumtoxinA (Dysport®), OnabotulinumtoxinA (Botox®), and IncobotulinumtoxinA (Xeomin®) Neurotoxin Content and Potential Implications for Duration of Response in Patients, Toxins, 2018.

        • Filipo R.
        • Spahiu I.
        • Covelli E.
        • et al.
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        Laryngoscope. 2012; 122: 266-270
        • Hetzler L.T.
        • Hershey M.
        • Lambert T.
        • et al.
        Anatomic considerations of perinasal musculature for improved dental show during smile in facial synkinesis.
        Facial Plast Surg Aesthet Med. 2022; 24: 89-94
        • Husseman J.
        • Mehta R.P.
        Management of synkinesis.
        Facial Plast Surg. 2008; 24: 242-249
        • Jowett N.
        • Hadlock T.A.
        A contemporary approach to facial reanimation.
        JAMA Facial Plast Surg. 2015; 17 ([Erratum in: JAMA Facial Plast Surg. 2015 Sep-Oct;17(5):386. PMID: 26042960]): 293-300
        • Jowett N.
        • Hadlock T.A.
        An evidence-based approach to facial reanimation.
        Facial Plast Surg Clin North Am. 2015; 23: 313-334
        • Klein A.W.
        Contraindications and complications with the use of botulinum toxin.
        Clin Dermatol. 2004; 22: 66-75
        • Leader B.
        • Azizzadeh B.
        Synkinetic unilateral lower lip palsy: diagnosis and technical considerations for facial reanimation.
        Facial Plast Surg Aesthet Med. 2021; 23: 309-311
        • Masuoka H.
        The visualization of the functional role of the depressor septi nasi muscle by ultrasound.
        Plast Reconstr Surg Glob Open. 2017; 5: e1406
        • Moran C.J.
        • Neely J.G.
        Patterns of facial nerve synkinesis.
        Laryngoscope. 1996; 106: 1491-1496
        • Shokri T.
        • Patel S.
        • Ziai K.
        • et al.
        Facial synkinesis: a distressing sequela of facial palsy.
        Ear Nose Throat J. 2021; (1455613211054627)