# Chronic Facial Paralysis Treated With Non-absorbable APTOS Barbed Threads: A Case Report With Anatomic Considerations

## TL;DR

A 23-year-old woman with chronic facial paralysis and nerve damage was treated using non-absorbable barbed threads to improve facial symmetry and appearance.

## Contribution

This case report introduces the use of non-absorbable APTOS barbed threads for treating chronic facial paralysis and its associated soft tissue alterations.

## Key findings

- APTOS barbed threads effectively improved facial symmetry and lifted the affected cheek and jowl areas.
- The procedure resulted in a more symmetric smile and a lifted mouth corner.
- Local anesthesia and minimally invasive techniques were successfully used for facial correction.

## Abstract

Chronic paralysis of the facial nerve leads to degenerative facial muscle and surrounding soft tissue alterations on the involved side, making the affected patients seem older than their actual age. Moreover, contralateral facial hypertrophy worsens facial asymmetry. Correction of the drooping or wrinkled face due to aging, trauma, or other pathology has been successfully treated with the thread-lifting technique. Here, we present the case report of a 23-year-old female patient suffering from oncologic post-surgery complications associated with chronic facial nerve paralysis. She also suffered from old and new cerebellar syndromes on the right side and lesions of the oculomotor, trochlear, and abducens nerves. Based on the patient history, the condition was treated under local anesthesia by the use of APTOS minimally invasive threads with barbs made from non-absorbable material. Correction and sculpting of the affected cheek area were performed by insertion of a light lift needle, and lifting of the superficial fat pads was secured by subdermal insertion of the light lift thread method. The jowl area was lifted by the superficial insertion of both types of threads. As a result, we significantly improved facial symmetry at rest, a more symmetric smile, a lifted corner of the mouth, and an anatomically sculpted cheek appearance.