1000 Section - Restoring Facial Balance after Long-standing Facial Nerve Palsy: Functional and Psychosocial Outcomes following Multimodal Injectable Treatment

Objectives : Chronic facial asymmetry secondary to facial nerve palsy either idiopathic or post-stroke constitutes a long-standing therapeutic challenge with broad functional and psychosocial repercussions. Persistent neuromuscular imbalance disrupts facial expressiveness, affects articulation and non-verbal communication, and often leads to social withdrawal. These limitations contribute to emotional distress, diminished self-esteem, and a substantial reduction in quality of life. For patients who reach a plateau with conventional rehabilitation techniques, minimally invasive injectable interventions offer the potential for meaningful complementary improvement by targeting both structural and dynamic components of facial dysfunction.

Design: This observational study reports outcomes from eight patients with chronic facial nerve palsy, evenly divided between Bell’s palsy and post-stroke etiologies. All participants underwent a standardized multimodal injectable protocol designed to improve symmetry, enhance dynamic movement, and restore soft-tissue support. The therapeutic approach combined botulinum toxin type A to modulate contralateral hyperactivity, hyaluronic acid fillers to address contour deficits and volume loss, and calcium hydroxyapatite (CaHA) to provide longer-term structural reinforcement. Functional and psychosocial status was systematically assessed using the Facial Disability Index (FDI) at baseline and after two treatment sessions.

Results: Following treatment, significant functional improvement was observed, with mean FDI Function scores increasing from 65.63  to 80.63 (p < 0.05). Psychosocial outcomes demonstrated a favourable trend, with FDI Social scores decreasing from 63.00 to 74.50  (p < 0.05), reflecting enhanced confidence, reduced social inhibition, and more comfortable interpersonal interactions. All participants reported subjective improvements in facial symmetry and smoother dynamic expression, contributing to overall satisfaction.

Conclusion: These findings support the use of multimodal injectable therapy as a valuable adjunct in managing chronic facial nerve palsy. Integrating neuromodulatory, volumetric, and biostimulatory interventions within a comprehensive rehabilitation framework may optimize facial balance, restore expressive function, and improve long-term quality of life for this challenging patient population.