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Persistent Pain a Year and Half After Face Lift

I had a Face Lift surgery performed 1.5 years ago. During three post-op visits to my surgeon, I addressed the issue of tingling in the right side of my face (the area closest to my ear and upper neck). Even the slightest touch to that area feels like needles pricking my skin. My surgeon told me that the nerves are taking a while to reattach and that in time all will heal. However, the tingling feeling has never gone away. I even reflexively pull away and wince when my baby touches me in that area. Since I have mentioned this numerous times to the same physician, I'm looking for additional opinions. Thank you for your consideration.

Doctor Answers (21)

Pain After Facelift

+3

I am very sorry to hear of your pain.

An injury to a sensory nerve (the Greater Auricular Nerve is the most typical) is possible during Facelift.

Although the painful sensations usually resolve with time, at this point, try the following:

  • sensory re-education: stroke the area of tenderness as much as you can reasonably tolerate. This can desensitize the nerve.
  • steroid injection may reduce nerve irritation
  • massage
  • medication: there are some specialized neuro-modifiers (like Lyrica or Neurontin) that might be useful
  • surgical scar or nerve release
  • neurology consultation


Denver Plastic Surgeon
4.0 out of 5 stars 12 reviews

Tingling after plastic surgery

+3

Dysesthesia, or an unpleasant sensation occurring this long after surgery may warrant further treatment.

Is there scarring or tethering that is causing the problem?

Usually nerve pains such as this go away shortly after surgery with massage and desensitization therapies. Patients are often surprised to find out that massage, though unpleasant at first, can often reduce or eliminate this type of nerve pain. Instinctively, the patient protects the area, but this just makes the problem worse.

If nerve pain persists, the patient may want to ask their surgeon about consulting with a neurologist or pain specialist. They can prescribe medications such as low dose neurontin to help reduce the nerve pain while the patient undergoes therapy specific for the pain.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 95 reviews

Pain after facelifting

+2

Depending on the nature and location of the pain, it may be worth re-elevating the skin (flap).  This has been reported to allow the nervers to re-innervate the skin.

While this isnt definitive, it is a simple enough thing to try to relieve your symptoms as this isnt typical.

Jon E. Mendelsohn, MD
Cincinnati Facial Plastic Surgeon
4.5 out of 5 stars 31 reviews

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Persisting pain after face lift may be a neuroma

+2

Sounds like you may be describing a neuroma. When nerve endings try and re-estable connections, they sometimes don't find the right connections. This then develops into a small ball of nerve endings which can be quite painful, even at the slightest touch. This can usually be corrected with additional surgery where this ball of nerve ending can be excised and buried. Either see your physician about this or seek another surgeon that can help you.

Kari L. Colen, MD
New York Plastic Surgeon
5.0 out of 5 stars 3 reviews

Greater auricular nerve injury after facelift surgery.

+1

You describe a neuroma in the greater auric ulnar nerve .  This is a sensory nerve that supplies sensation to the ear. Injury to this nerve can also cause sweating in the cheek area when chewing.

The treatment at this point is to explore the nerve find the neroma excise and repair.  Not a 100% cure rate but the next step in my option after a year and a half.

Miguel Delgado, Jr., MD
San Francisco Plastic Surgeon
4.5 out of 5 stars 30 reviews

Persistent Pain 1.5 Years after a Facelift

+1

Dear AnnChloe,

It sounds like the great auricular nerve was injured during the facelift.  This injury can be common after a facelift.  Usually, altered sensation in this area ranging from decreased sensation to hypersensitivity can be experienced for up to 3-6 months after the surgery.  In cases of hypersensitivity, it is best to stimulate the area with touch and different materials.  You can start with a feather and work your way up to more firm objects/textures.  

In your case, it sounds like there was more than a simple neuropraxic injury (nerve bruise).  I worry that you may have a neuroma (scar tissue in nerve) at the site where the nerve was injured.  If this is the case, you would need the incision to be opened in the area of the great auricular nerve, and have the nerve buried in fat or muscle so that your sensitivity resolves.  It may also be possible to cut out the scarred section and repair the nerve.  It would depend on how the nerve appeared under an operating microscope to decide how to treat the neuroma.  

I suggest seeing your surgeon again and mentioning this possibility.  If you feel like your surgeon isn't listening to you, I suggest you seek a second opinion.

I hope this helps.

Sincerely,

Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

Pain long after a face lift

+1

The source of your pain needs to be localized before it can be treated.

Your problem is called dysesthesia. At this point you are most likely to have

  1. a trapped nerve
  2. a neural excitatory problem (nerves haven't calmed down since surgery).
  3. an underlying nerve problem made worse by surgery.

What to do: 1. have your surgeon find the trigger point and numb it. Do this 3 x a week for two weeks, while you retrain the nerve. (stroking skin to 'tell' it what normal is again) 2. if no better, re-operate to try to find the nerve and release it. These are difficult problems. But they can be corrected. Good luck.

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.5 out of 5 stars 21 reviews

Persistent pain 18 months after facelift

+1

Pain 18 months after the procedure is certainly not normal.  It is not unusual to have this in the first few months after surgery but it typically goes away within the first 6-12 months.  I agree with trying massage as an initial step.  Although it seems counter intuitive, it may help decrease your sensitivity.  Evaluation by a neurologist might be helpful if the massage does not adequately relieve your symptoms.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.5 out of 5 stars 42 reviews

Unusual pain after face lift surgery!

+1

Sorry to hear that you're experiencing discomfort with your face lift procedure. This is an unusual event. Out of nearly two thousand face lift procedure I have performed, I had one patient in the past that experienced similar prolonged discomfort. After treatment with Neurontin, Kenalog injection to the triggered point, as well as massaging her discomfort resolved. Wish you well.

Kevin Sadati, DO
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 97 reviews

Chronic pain after facelift.

+1

Prolonged pain after surgery is very uncommon and as such there is no protocols or extensive studies that support the most common causes. There are multiple reasons why chronic pain may be present.

One of the reasons would be increased sensitivity or irritibility of the nerves. In my practice I have seen this a few times in patients with MS or other neurological problems.

Plastic surgery of the face just like any surgery can increase the patients sensitivity and result in chronic pain. The treatment involves physical therapy with progressive increases in roughness of the material aka desensitization. We have also had some success in some patients by using Lyrica, anti inflammatory nutrition including vitamin C, fish oil and CO-Enzyme Q. Anti inflammatories such as tylenol occasionally are effective, but in my experience Celebrex may work better.

Because, we truely do not know what causes your specific problem it may not be an easy problem to solve.

Other reasons for chronic pain could be a reaction to the suture material. We rarely test the suture material against the patients immune system, however in the last 10 years I have seen a single patient with an allergic reaction to a suture material. Usually this testing can be done by an allergy specialist or some alternative medicine specialists. The treatment usually involves steriods, which I personally like to avoid as much as I can, or surgically removing the sutures.

I agree with the previous authors that a true neuroma on the face is rare, however if there is Kenalog may be adequate.

Some pain specialists may also inject alcohol or other substances to decrease the sensation of these small nerves, I have not done this personally and cannot vouch for the success. But if the symptoms are resulting from a small nerve impingement due to scar tissue this may be a reasonable otption.

Also, there is a small possibility of infection. Infection is extremely uncommon on the face, however in patients with RA or other auto-immune diseases or with altered immunity this needs to be taken into consideration.

I do not think I can diagnosis this over the internet or phone, but if the symptoms persist for a long time you may need more aggressive investigation. The best way is to discuss it openly with your surgeon and maybe ask him/her to refer you for a second opinion. I commonly do that with challenging problems, because it is very easy to get tunnel vision and sometimes a different persepctive on the problem is helpful.

Boris Volshteyn, MD, MS
East Brunswick Plastic Surgeon
4.0 out of 5 stars 8 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.