Facial paresis: a worrying event related to labial herpes simplex and periocular botulinum toxin a injection

Angela Faga; Silvia Scevola; Elena Dalla Toffola; Giovanni Nicoletti

doi:10.57662/am.v9i3.15190

Facial paresis: a worrying event related to labial herpes simplex and periocular botulinum toxin a injection

Authors

Angela Faga University of Pavia
Silvia Scevola Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Pavia, Italy 2. “NUOVO” Outpatient Facility, Viale della Libertà, 17, 27100 Pavia, Italy
Elena Dalla Toffola Physical Medicine and Rehabilitation, Department of Clinical Surgical, Diagnostic an Pediatric Sciences, University of Pavia, Pavia, Italy
Giovanni Nicoletti Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, Plastic and Reconstructive Surgery, Department of Clinical Surgical, Diagnostic an Pediatric Sciences, University of Pavia, Surgery Unit, Azienda Socio-Sanitaria Territoriale di Pavia, Pavia, ItalyPavia, Italy

Keywords:

Botulinum toxin, Herpes simplex virus, facial palsy

Abstract

The Authors report on a case of facial paresis following reactivation of labial Herpes simplex in a 59 years woman treated with sequential periocular BoNTA injection and blepharoplasty. A mild palsy occurred on the whole right hemiface 12 days after upper blepharoplasty, 22 days after BoNTA injection (40 U) in the periorbital area and in the glabella.

The patient was treated with Acyclovir for 5 days and with oral B complex vitamins for 12 weeks. The symptoms slowly recovered in 4 months.

Facial paresis might have been simply triggered by an invasive treatment related inflammatory reaction. Nevertheless, the Herpes virus might have promoted the anterograde diffusion of the toxin, previously migrated from the site of injection to the facial nucleus through a retrograde pathway.

The Authors suggest Acyclovir prophylaxis in patients affected by recent or recurrent forms of Herpes simplex infection when planning BoNTA injection in the face.

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