CONCLUSION: Rehabilitation was significantly efficient in both groups of patients with synkinesis, especially in those in whom treatment with botulinum toxin type A (BTX-A) preceded physical rehabilitation. OBJECTIVE: To determine the influence of preventive treatment with BTX-A on synkinesis when physical rehabilitation is planned. METHODS: Twenty patients, who recovered from facial palsy with final House-Brackmann (HB) grade II and III, were randomized to assess the efficacy of preventive BTX-A treatment on final synkinesis score after physical rehabilitation. Synkinesis was graded according to the four-point scale derived from the SunnyBrook Facial Grading System (FGS). Physical rehabilitation was carried out using NeuroMuscular Retraining Therapy (NMRT). In the randomized groups, NMRT was administered with (group a) or without pre-BTX-A treatment (group b). RESULTS: Patients who were preliminarily treated with BTX-A in the affected area showed a 2.1 improvement of score on the SunnyBrook scale (p < 0.001), with significantly better results in comparison to the non-BTX-A group.