AA cosmetic surgery that uses injections of
hyaluronic acid to make lips appear fuller could
also improve the lives of people with facial
paralysis, according to results of a small study by
researchers at Johns Hopkins and Stanford
universities.
Facial paralysis causes both physical and
psychological problems, says Kofi Boahene, M.D., a
facial plastic and reconstructive surgeon in the
Department of Otolaryngology-Head and Neck Surgery
at the Johns Hopkins University School of Medicine
and an author of a published report about the study
appearing June 18 in the journal JAMA Facial Plastic
Surgery. “It’s a very large problem,” he notes,
“that can occur because of stroke, Bell’s Palsy,
muscular dystrophy, trauma and birth defects.”.
Without lip control, patients struggle with
drooling, eating and drinking without spillage, and
making sounds that require fully closing the lips,
such as words containing the letters “b” and “p.”
Many individuals with facial paralysis also become
self-conscious about how they look.
Boahene says he stumbled across a possible role for
hyaluronic acid injection while working with a
patient with a then-undiagnosed case of muscular
dystrophy. Her face was weak, and she had trouble
speaking. To improve her lip muscle tone, he tried
the injection and says the effects were immediate.
Her face appeared stronger, and her articulation
markedly improved.
“To maintain structure, plants fill their leaves and
stems with water,” Boahene says. “It’s a crude
analogy, but injecting the lips with hyaluronic acid
works in much the same way. It tones the tissue
surrounding the muscle.”
To test the procedure, Boahene and his collaborators
recruited 22 patients (14 women and eight men) with
facial paralysis on one side of the mouth along with
three patients with muscular dystrophy who had lost
control of both sides of the mouth.
Baseline measures of lip tone were performed by
having participants place their lips around an
instrument that measured pressure and took readings
from the left, middle, and right sides of the mouth.
(The three patients with muscular dystrophy suffered
from uniform weakness across the lips, while the
rest of the patients had lost control on one side
only). The researchers then identified the weakest
points by having participants blow air with pursed
lips. At points where air escaped, the researchers
injected the hyaluronic acid.
Boahene says the findings were striking, with the
greatest improvement seen in the three patients with
muscular dystrophy, whose lip strength increased
six- to sevenfold over the original reading. For
participants with paralysis on only one side of the
mouth, lip strength increased an average of 1.4-fold
on the paralyzed side and 0.4-fold on the unaffected
side.
To see how well those improvements carried over to
daily life needs, a speech therapist conducted a
before-and-after assessment of the patients’ ability
to speak and to eat and drink without spilling.
All 25 patients showed marked improvement, Boahene
says. Plans are underway to confirm the benefits in
a larger study with about 100 patients.
The effects of the injections, which cost between
$500 and $2,000, are temporary, lasting about a year
when done for cosmetic purposes. When done for
cosmetic improvement, insurance typically does not
cover the bill. However, insurance companies
typically make an exception when the benefits are
primarily therapeutic, Boahene says. Lip injection
is a minimally invasive outpatient procedure that
can be performed by dermatologists and plastic
surgeons; however, Boahene says, it is important
that therapeutic injections be performed by
physicians experienced in treating and managing
facial paralysis and muscle weakness.
Boahene says that if the 25 patients continue to
show improvement without any marked side effects, he
might pursue tests of longer-lasting solutions, such
as removing fat from elsewhere in the body and
injecting it around the mouth.
Moreover, he says, the procedure may also help
patients whose facial nerves have been repaired but
who need temporary lip help while full healing from
such repairs occurs.
Other authors on the paper are Heather Starmer of
Stanford University and Sofia Lyford-Pike, Lisa
Earnest Ishii, and Patrick Byrne of The Johns
Hopkins University.
For more information
JAMA Facial Plast Surgery
Quantifying Labial Strength and Function in Facial
Paralysis: Effect of Targeted Lip Injection
Augmentation
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