Role of Hyaluronic Acid Fillers in Facial Paralysis
Minahil Iqbal, Amina Berour, Macram Wakim, Zuha Ajlan, Nancy Emmanuel, Gregory Nicolas, Juan P. MenéndezBackground:
Facial paralysis results in multifaceted functional and aesthetic deficits, including lagophthalmos, oral incompetence, and profound asymmetry. Although surgical reanimation is the primary treatment for functional restoration, hyaluronic acid (HA) fillers have emerged as a minimally invasive adjunctive tool for soft-tissue support and aesthetic refinement.
Methods:
A comprehensive narrative review was conducted using PubMed, Embase, Scopus, and the Cochrane Library databases through November 15, 2025. This study follows the rigorous methodological framework for narrative synthesis, emphasizing clarity of scope, reflexivity, and thematic sufficiency. Studies evaluating HA fillers for lagophthalmos, oral competence, and facial symmetry were analyzed.
Results:
Data from prospective and retrospective studies indicate that HA fillers can notably improve lagophthalmos by providing mechanical lid loading, reducing residual gaps from an average of 5.5 to 0.8 mm. In the perioral region, HA injections have been shown to increase labial strength by 1.4-fold, reducing bolus spillage and improving speech articulation. Patient-reported outcomes show substantial improvements in psychosocial distress (
Conclusions:
HA fillers provide immediate mechanical and aesthetic benefits as an adjunctive treatment for facial paralysis and should be considered complementary to surgical interventions where indicated; however, they do not restore nerve function and cannot replace surgery. Future research must focus on standardized protocols and the long-term safety of periorbital injections.