Botox versus Surgery: Evaluating Patient Treatment Choices for Post-Paralysis Facial Synkinesis.

Abstract

Background: Treatment selection for post-paralysis facial synkinesis (PPFS) is a multifaceted decision for patients. This study aims to identify patient factors influencing treatment choice between chemodenervation with onabotulinumtoxinA (Botox) alone and synkinesis surgery.

Methods: PPFS patients presenting between 2009 and 2024 were grouped into those choosing only chemodenervation and those choosing synkinesis surgery. Excluded were untreated patients and those without qualifying photos at least 16 months post-paralysis onset. eFACE was used to quantify synkinesis severity. The primary outcome was choice of treatment type, and the secondary outcome was time from synkinesis diagnosis to surgery. Each was analyzed for associations with patient characteristics using univariable and multivariable analysis.

Results: Of 549 PPFS patients, 231 patients met inclusion criteria. Factors independently associated with selecting surgical treatment included living more than 100 miles from our institution (p < 0.001) and moderate or severe synkinesis (p = 0.010). Time from synkinesis diagnosis to surgery was significantly longer for female patients compared to male patients (adjusted mean difference 441 days; p = 0.025) and for non-White patients compared to White patients (adjusted mean difference 355 days; p = 0.042). Other variables including socioeconomic vulnerability were not found to be independently associated with selection or timing of treatment.

Conclusions: Patients living farther from our institution and those with more severe synkinesis were more likely to choose surgical synkinesis treatment over chemodenervation alone. The time from synkinesis diagnosis to surgery was significantly longer for female compared to male patients and for non-White compared to White patients.