Impact of Botulinum Toxin injection on Improving Facial Symmetry and Quality of Life in Patients with Long-Standing Peripheral Facial Palsy

Background: Facial palsy can cause significant psychological and social challenges, severely affecting quality of life. Botulinum toxin (BoNT) injection is an effective treatment for persistent facial palsy, enhancing facial symmetry, and alleviating issues such as involuntary muscle movements and tightness. Objective: This study aimed to evaluate how patients with long-standing facial palsy experienced changes in their quality of life before, one month after, and four months after receiving botulinum toxin (BoNT) injections using three specific questionnaires: HFS-30, FaCE, and HAD. Additionally, the study sought to identify clinical factors linked to improvements in quality of life and assess the applicability of the HFS-30 questionnaire to patients with unilateral facial palsy. Methods: The study included 88 patients with long-standing unilateral facial palsy. Data were collected on demographics, medical history, facial palsy history, and botulinum toxin injection details. Quality of life was assessed using the HFS-30, FaCE, and HAD questionnaires before the injection, and at one and four months post-injection. Statistical analyses were performed using paired Student’s t-test, Pearson’s correlation coefficient, and linear regression models. Ethical approval was obtained from the IRB (approval number 20211130113517), and all participants provided informed consent. Results: Eighty-eight patients participated, with 63 women (72%) and 25 men (28%), averaging 53 years old (SD 15.8). Significant improvements in quality of life were observed one month post-injection, with the HFS-30 score improving from 45.1 (SD 22) to 35.4 (SD 20.5) (p < 0.0001) and the FaCE score improving from 50.2 (SD 24) to 59.3 (SD 22.1) (p < 0.0001). The HAD score improved from 13.8 (SD 6) to 12.2 (SD 5.8) (p = 0.0032). At four months, the improvements in HFS-30 and FaCE scores were sustained (HFS-30: 35.3, SD 21; FaCE: 58.1, SD 23), while the HAD score showed no significant change from baseline (12.9, SD 5.7). Conclusion: This study demonstrated that BoNT injection significantly enhances the quality of life of patients with unilateral facial palsy. The benefits of this improvement persisted for at least four months post-injection. Younger patients and those with shorter disease durations experienced more substantial improvements, highlighting the potential of early intervention.