Neurological facial disorders and the use of botulinum toxin therapy

Objectives: Objective. To describe a series of clinical cases of hemifacial spasm identified in patients seeking aesthetic procedures, and to evaluate the role of botulinum toxin therapy in managing these conditions. Introduction: Hemifacial spasm (HFS) and sequelae of facial nerve neuritis represent significant clinical and aesthetic challenges, affecting both functional status and quality of life. In recent years, there has been an increase in patients seeking aesthetic procedures, including botulinum toxin injections and dermal fillers. This trend introduces diagnostic complexity, particularly when the onset or exacerbation of neurological symptoms temporally coincides with cosmetic interventions. Materials / method: Materials and Methods. We present two clinical cases of patients with documented hemifacial spasm, characterized by involuntary contractions of the muscles of the left side of the face and neck innervated by the facial nerve. The patients sought cosmetic treatments (botulinum toxin injections and dermal fillers), attributing the worsening of symptoms to these procedures. Clinical examination, detailed medical history, and instrumental diagnostics, including magnetic resonance imaging (MRI), were performed. Results: Results. In both cases, no causal relationship was found between the cosmetic procedures and the onset or progression of hemifacial spasm. MRI findings revealed vascular changes in the region of the facial nerve nucleus, consistent with known pathophysiological mechanisms of HFS (neurovascular conflict). Thus, the temporal association with aesthetic procedures was coincidental. Additionally, patients with an established diagnosis and awareness of the chronic nature of their condition were evaluated. In such cases, botulinum toxin therapy serves as an effective symptomatic treatment. Conclusion: Conclusions. 1. The temporal coincidence of hemifacial spasm onset or exacerbation with cosmetic procedures does not imply a causal relationship. 2. Neurological evaluation and MRI are essential to exclude organic pathology. 3. Botulinum toxin therapy is an effective and safe method of symptomatic management in confirmed cases. 4. A multidisciplinary approach involving neurologists and aesthetic medicine specialists provides optimal functional and aesthetic results.