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Injecting botulinum toxin A (known commercially as Botox) appears to be a safe procedure to improve smiles by restoring lip symmetry in children with facial paralysis, a condition they can be born with or acquire because of trauma or tumor, according to a report published online by JAMA Facial Plastic Surgery.

Botulinum toxin A is an effective treatment in adults to achieve facial symmetry after facial paralysis but few investigators have described its use in children, according to the study background. Severe cases of facial paralysis can require surgical reconstruction, whereas milder cases can be treated with muscle transfer and other techniques, or patients can be managed nonsurgically with physiotherapy and rehabilitation strategies. When treated with botulinum toxin A, the injection is given so as to weaken the strong muscles on the nonparalyzed side of the face.

Siba Haykal, M.D., Ph.D., of the University of Toronto, Canada, and coauthors reviewed medical records and identified 18 children with facial paralysis treated with botulinum toxin A injections from 2004 through 2012. The authors used facial analysis software to measure lower lip symmetry in patients’ smiling photographs before and after treatment.

The authors did not observe complications in patients who received botulinum toxin A and facial symmetry improved.

“We have shown that botulinum toxin A significantly improves symmetry of the lower lip, is safe and has a potential for restoration of permanent symmetry,” the study concludes.