A plastic surgery approach to Meige syndrome: Botulinum toxin for rebalancing facial dystonia and aesthetics – A case report

<h2>Abstract</h2> Meige syndrome is a rare segmental dystonia characterized by blepharospasm and oromandibular dystonia, often leading to significant functional and aesthetic impairment. This report details a 59-year-old female patient with a 16-year history whose symptoms were refractory to prior drug therapies. An individualized botulinum toxin type A (BTX-A) injection protocol was devised based on detailed facial muscle mapping and plastic surgery principles of muscle balance. Following treatment, the patient showed marked improvement in facial spasms within one week, with resolution of nocturnal headaches and notable correction of aesthetic concerns arising from dystonia, including facial asymmetry and the involuntary "gummy smile". The gingival exposure during dystonic contraction was reduced from >4 mm (classified as severe gingival smile) to 1 mm. Social and eating functions were restored. This case suggests that a BTX-A treatment strategy guided by plastic surgery principles, which addresses both functional symptoms and aesthetic disharmony, may provide an effective and safe office-based treatment option for Meige syndrome. Further studies with larger cohorts are warranted to validate this protocol.