Background Facial nerve injury after facelift is rare; hence, its treatment is poorly established. Botulinum toxin type A (BTXA) can be used to resolve the asymmetry. There is no protocol in the literature about the best timing for this treatment, injection sites or recommended dose. Objectives Propose a protocol to guide the management of asymmetries post-facelifts. Methods Fifteen patients with post-rhytidectomy facial palsies were treated in the non-paralyzed side with BTXA. After analysis of the smile deviation vectors, it is possible to identify the muscles that should be treated. The dose varied from 1-2 Uv/point. Patients were examined after 15 days for outcomes evaluation, and “touch-up” if needed. Patients were re-treated after 5-6 months in case of asymmetry recurrence. Results Symmetry was achieved in all cases. Six patients had definitive nerve lesions and needed to be treated every 6 months after the first session. Five patients had lesions affecting the upper third of the face, four of them were definitive nerve lesions. Two of the four patients who were treated less than 2 weeks after surgery recovered early from the post-facelift paralysis and developed reversed asymmetry due to the BTXA. In seven patients, the post-facelift asymmetry was due to neuropraxis: the recovery from the nerve injury and BTXA treatment occurred symmetrically on both sides of the face in the following months, after one single session. Conclusions Asymmetries post-facelifts were successfully managed with the proposed protocol. Best time for injection was 2-4 weeks after surgery.

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A 50-year-old woman sought medical consultation due to a 7 3 8-millimeter pigmented lesion on the left nipple. It had been present for one year and showed growth for the past 6 months. The patient had a history of left breast cancer, which had been treated with 36-radiotherapy sessions on the areolar region. Clinically, the lesion was sharply demarcated with a velvety surface. Reflectance confocal microscopy (RCM), a near-infrared low-power laser (830-nm diode, power \ 35 mW; Vivascope 1500, Caliber ID), and digital dermoscopy (Medicam 1000; 203 magnification, FotoFinder Systems GmbH) were performed prior to biopsy.