Aesthetic Rehabilitation of Patients with Central and Peripheral Facial Palsy with Injectables (BNT-A, HA-Fillers and CaHA)

Sep 30, 2026

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Facial palsy is a disabling condition that impairs function and facial appearance, lowering patients’ quality of life. A combined pharmacological approach using botulinum toxin (BoNTA), hyaluronic acid (HA), and calcium hydroxylapatite (CaHA) may improve outcomes. A single-center experience evaluated patients with central or peripheral facial palsy treated with BoNTA+HA+CaHA over six months (Jan 2025–Jun 2025).

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Central vs peripheral facial palsy

Methods and results

Safety and adverse reactions

Facial Disability Index (FDI) outcomes

Conclusions

Article Aesthetic Rehabilitation of Patients with Central and Peripheral Facial Palsy with Injectables (BNT-A, HA-Fillers and CaHa) Athanasios Tsivgoulis 1,2, Eleftherios Stefas 3, Georgios Galatas 4, Georgia Papagiannopoulou 2, Stella Fanouraki 2, Maria-Ioanna Stefanou 2, Pinelopi Vlotinou 2,5, Christina Zompola 2, Georgios Tsivgoulis 2 and Aikaterini Theodorou 2, * Academic Editor: Stefan Lorenzl Received: 3 December 2025 Revised: 27 December 2025 Accepted: 2 January 2026 Published: 5 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Attica Rehabilitation Center, 19018 Athens, Greece; [nasost02@yahoo.gr](nasost02@yahoo.gr) 2 Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine,“Attikon” University Hospital, 12462 Athens, Greece; [georgiapap22@hotmail.com](georgiapap22@hotmail.com) (G.P.); [stelfanou@gmail.com](stelfanou@gmail.com) (S.F.); [marianna421@hotmail.co.uk](marianna421@hotmail.co.uk) (M.-I.S.); [pakivlot@yahoo.com](pakivlot@yahoo.com) (P.V.); [chriszompola@yahoo.gr](chriszompola@yahoo.gr) (C.Z.); [tsivgoulisgiorg@yahoo.gr](tsivgoulisgiorg@yahoo.gr) (G.T.) 3 Department of Neurology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; [stefaspmr@gmail.com](stefaspmr@gmail.com) 4 First Department of Internal Medicine, Sismanoglio General Hospital, 15126 Athens, Greece; [giorgosgalatas@gmail.com](giorgosgalatas@gmail.com) 5 Department of Occupational Therapy, School of Health and Welfare Sciences, University of West Attica, 12243 Athens, Greece * Correspondence: [katetheo24@gmail.com](katetheo24@gmail.com); Tel.: +30-6973078415; Fax: +30-2105832471 Abstract Background: Facial palsy constitutes a profoundly disabling condition, often leading to marked functional deficits and a decline in facial appearance, which substantially reduces the patient’s quality of life. A combined therapy of botulinum toxin (BoNTA), hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) appears promising in the pharmacological approach of these patients. Methods: We reported our single center experience of patients with facial palsy, either of central or peripheral etiology who were treated with the combination of BoNTA, HA and CaHA, during a 6-month period (January 2025–June 2025) . Results: Eight consecutive adult patients [mean age: 49.50 ± 7.95 years, 6 (75%) female] with facial palsy, either of central (4 patients) or peripheral (4 patients) etiology, received the combination of BoNTA, HA and CaHA. No serious adverse reactions were documented. Localized bruising and swelling at injection sites resolved without requiring any additional intervention. Facial Disability Index (FDI) was assessed both prior to and following treatment. The functional subscale increased from 65.63 ± 16.13 to 80.63 ± 10.50 (improvement rate = 24.4%, p-value = 0.002), while the psychosocial subscale increased from 63.00 ± 17.34 to 74.50 ± 10.89 (improvement rate = 18.3%, p-value = 0.004) . Consequently, the total FDI score improved from 128.63 ± 28.92 to 155.13 ± 17.96 (overall improvement = 20.6%, p-value = 0.001) . Conclusions: The present case series underscores the potential therapeutic role of CaHA as an adjunct to BoNTA and HA injections in patients with central or peripheral facial palsy. Keywords: facial palsy; rehabilitation; botulinum toxin; hyaluronic acid and calcium hydroxylapatite; injections 1. Introduction Facial palsy can result from either central (upper motor neuron) or peripheral (lower motor neuron) lesions [1] . Central facial palsy, most commonly caused by a contralateral stroke affecting the corticobulbar tract, produces weakness of the lower face while forehead movement and eye closure are preserved due to bilateral cortical innervation [2] . Clinically, this manifests as mou

FAQs

What treatment combination was evaluated for central and peripheral facial palsy?

The study evaluated a combined approach using botulinum toxin (BoNTA), hyaluronic acid (HA), and calcium hydroxylapatite (CaHA) injectables.

How long was the treatment period, and when were patients treated?

Patients were treated during a six-month period from January 2025 to June 2025.

What were the key findings on Facial Disability Index (FDI) after treatment?

FDI improved after treatment, with the functional subscale and psychosocial subscale both increasing significantly, leading to an overall FDI score improvement.

Sep 30, 2026

Uploaded by Bulrr