Objective: To show our therapeutic outcome of botulinum injection to the facial muscles and thereby to find the best therapeutic concept which should be embraced.

Background: Treatment of the facial muscles woth botulinum toxin is usually effective and safe. As yet, side effects may limit the therapeutic effect in some cases.

Method: The decision to treat the lower eyelid with 1-point or 2-points injection was randomly taken as there is no consensus regarding this debate.  Injections to the lateral end of the upper eyelid were performed more laterally to the conventional injection point, just lateral to the conjunction of the upper and lower eyelids.

Results: Twenty-Eight patients (22 females, 14 hemifacial spasm, 9 blepharospasm, 5 post facial palsy synkinesis) were enrolled. Data was retrieved from 128 visits between the years 2019 and 2021. The most frequent score of the patient global impression of change was “marked improvement” scoring 63 times (61.8%), followed by moderate and mild improvement (24.5% and 7.8%, respectively). Overall, 86.3% of the treatments had moderate or marked improvement. The most common side effect was facial weakness with 16 times (15.8%). Neither ptosis nor diplopia was noted. Two-points regimen in the lower lid was associated with a lower risk of facial weakness (p=0.05) as compared to 1-point regimen, without a compromise of the therapeutic effect.

Conclusion: Two-points injection of the lower eyelid is preferable over 1-point injection. Injection of the pretarsal segment of the upper eyelid, just onto or even lateral to the conjunction of the upper and lower eyelids, lowers the risk of ptosis.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/therapeutic-approach-to-botulinum-injections-for-hemifacial-spasm-post-facial-paralysis-synkinesis-and-blepharospasm/