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Scary Dental Block Reaction Prior to Restylane (Third Time) - Massachusetts

I went to the same Doctor for the 3rd time (no...

I went to the same Doctor for the 3rd time (no prior problems) to have Restylane injected into my upper lip. I received a Dental Block (lidojust as I had before, but this time it was then injected the other side of my face, which was also way painful than usual, though not quite as bad as the left side. When I complained of excruciating pain, he gave me a shot of saline and that did help the pain subside. However, I immediately swelled in my cheeks, and we did not do the Restylane.

He thinks I had a reaction to the preservative in the lidocaine. I am skeptical because I have never had a problem with lidocaine in my life, and have had plenty of dental work, etc. The next day my face was so swollen and completely numb that I could barely smile, and I could not feel anything. I had this in late March, and it is July and I am just now completely back to normal.

The swelling lasted about 2 weeks (the worst of it gone after one week), but my smile was partially paralyzed for weeks and I did not regain total feeling for months! It was terrifying.

I went to a few neurologists and plastic surgeons to get their opinions and they seemed to think that it was injected directly into the nerve (a fluke accident, not necessarily the doctor's fault). My friend is a dentist and he said no one is allergic to lidocaine. I'm not sure it was injected into a nerve because the saline dilution injection did help, and all the doctors said it was unlikely that he would hit a nerve on both sides. However, it was excruciatingly painful, and upon the first injection (on the left inside of my upper-lip, below the cheek) the pain went shooting all the way up to my left eye, in a fluttering sensation.


 **UPDATE** I am fully recovered, and I...

 **UPDATE** I am fully recovered, and I recently ran into the Doctor who did this, at a restaurant in town (we were both getting take-out), and he looked as if he had seen a ghost when he saw me.  He was very uncomfortable, very awkward, and VERY quick to get out of my sight.  I had to be the one to say "hi", and I did because I couldn't believe he was going to ignore me after looking me in the eye.  He did not forget me, as I was in there once a week after this happened so they could monitor what was going on with my frozen, swollen face,  I needed to say something to get him to acknowledge me, and so I said  "I'm all healed".  He said "oh good", very nervously, and rushed out.  It was very dismissive.  It angered me because I could have sued him -- I think most people would have and I was even advised to, but I didn't because I figured anyone can hit a nerve, it wasn't intentional.  I felt very brushed off and that he was very sleazy.  I will name him now, after all this time trying to be respectful of him and his practice, but he doesn't care about me at all, I believe he was only trying to protect himself from getting sued.  

I want to know what other doctors think this could be, and if anyone else has had a similar experience.

Natick Plastic Surgeon

I am not sure this was his fault. He was a little arrogant but I do think he felt bad and he is a good doctor, so I don't really want to comment on whether or not I would recommend him. Highly skilled, I think, but not a great "bedside manner".

3 out of 5 stars Overall rating
2 out of 5 stars Doctor's bedside manner
4 out of 5 stars Answered my questions
3 out of 5 stars After care follow-up
3 out of 5 stars Time spent with me
3 out of 5 stars Phone or email responsiveness
2 out of 5 stars Staff professionalism & courtesy
1 out of 5 stars Payment process
2 out of 5 stars Wait tmes
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Hi ladies. I'm suffering from partial face paralysis. 2 1/2 weeks ago a derm injected Resylane into my tear trough (no block) and I immediately felt numbness and pain down one side of my face. now i cant smile on one side and I cant leave my house. is there anything youve learned to speed the process of healing? Its horrifying.
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Has any progress been made at all? My nightmare completely resolved but it took a month or so.
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Dear KGB, I am a board certified plastic surgeon from Mexico city, Mexico. I read your story and though I can't find your pictures I can add my opinion on this most unusual and interesting case. I don't agree with Dr. Czapla on the intravascular lidocaine administration, though the burning symptoms he describes are correct, the pain is delayed until the actual liquid starts to run through the vessel, so it is ALMOST immediate but not on the very same moment the needle advances. Also, you would have a developed a characteristic "mottled" skin appearance with paleness and coldness that would have lasted for some hours. If I understand correctly you felt a sharp stabbing pain that shoot to your eye immediately, is that right? I think in that point the doctor may have hit the infraorbital nerve trunk as it exited the forame by which it enters the face. Was the needle long? (more than an inch long). Did he use 4% Articaine w/ epinephrine instead of Lidocaine with epinephrine? (Articaine has been epidemiologically linked to a greater number of local anesthetic related nerve injuries). Even though he may have hit the nerve, usually if one doens't administer the lidocaine then the pain and symptoms dissapear promptly. If he injected INTRANEURALLY or inside the infrorbital foramen (hole/tunnel) where the nerve travels, then you would have a neuropraxia (a mild form of nerve damage) which would last about 12 weeks and that would 100% explain the symptoms you describe as numbness on that half of the face in the lower eyelid, side of the nose and upper lip/cheek areas mostly.... The rare thing here is.. you shouldn't have had any MOTOR problems i.e. palsy, swelling, weak smile, slurred speech, etc. Because those muscules are animated through the FACIAL nerve, not the infraorbital (Trigeminal) Nerve. So... What you describe is a MIXED nerve injury. 1) Infraorbital nerve (a branch of trigeminal nerve) - the one the Doc was trying to anesthesize and 2) the buccal branch of the Facial nerve (motor). The Facial nerve's buccal branch's anatomical situation deosn't allow to be easily injured by a needle when the doc directed it towards the infraorbital nerve, but you probably had also a neuropraxia there, because even though I havent seen pictures, you describe swelling, maybe that was not swelling but buccinator weakness, also you describe your smile as very weak, so I can guess some other muscles (Risorius, Levator Labii Superioris, Levator labii superioris and nasal alae and levator anguli oris) where weakened too by the buccal nerve damage. So how can you damage two different nerve territories with ONE injection on one site only? I can only think you had a DIRECT INTRANEURAL damage to the infraorbital nerve and a facial nerve buccal branch damage when the needle was travelling through the tissues from the intra mouth injection site to the infraorbital nerve (very very bad luck - maybe the needle placement was too medial? i.e too close to the central upper incisors teeth). The other possible explanation is that he 1) hit the infraorbital nerve and injected intraneurally as I rpevisouly described thus causing SENSITIVE symptoms and 2) you may have developed an hypersensitivity reaction not to the lidocaine itself (there are very rare but quite possible and danegrous, your dentist friend is ill-informed on this), but to metabisulfite and/or parabens (more common) , which are common preservatives added to the lidocaine solution (sometimes the lidocaine container doesnt even tell you this!), this local-regional reaction can explain the swelling and also the buccal nerve damage. So what would I advice for future dental procedures or oral blocks? 1) Go and have a lidocain allergy test, a paraben allergy test and a metabisulfite allergy test. 2) Ask your physician to get preservative free lidocaine (a powder which has to be mixed right there and used immediately or it can get bacteria colonization) 3) Ask him to use the minimum gauge needle possible and with a short length using the "push ahead" or anterograde injection to avoid hitting the trunk and hit but the most terminal smaller brances of the nerve. Or 4) Use a "Magic Needle" or "DearmSculpt" hollow blunt micro cannulae, this way the nerve damage is almost 100% eliminated. I hope that made sense and I hope you find some value in it. Best regards, Marcelo-Oswaldo, M.D.
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Wow, Dr. Oswaldo. Thank you for the thoughtful response. I am afraid to have dental work done, and have been putting off work that I need because of it. If it would help, I would be happy to send you the pictures. I took them down because they were so awful, I didn't want anyone i knew to come across them. Let me know if they would be helpful to see and I can re-post them or send them to an email address. Thanks again. That was very helpful.
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You are welcome. I will PM you my personal email address. I forgot to add, it it were have been an intravascular injection you would've most certainly developed an echimotic (blue black) patch on your cheek's skin, adding to the symptoms I already described. I will analize your pictures and ask you some questions and when I reach a likely conclusion will post here so hopefully someone can benefit from this case of yours. ADDENDUM: One of the blunt needle's brand is DermaSculpt, not "DearmSculpt".
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Hi Dr. Oswaldo. Wow. You're so knowledgable about this. I've seen a plastic, 2 neurons and an net for my situation with no information as to any prognosis for me. A Derm injected Restylane into my tear trough and I suffered numbness initially. A week later she tried to reverse with arbitrage and it was at that time that I immediately lost full movement in the side of my nose, upper lip and ultimately my smile. My mouth turns down also on one side, it's been 5 weeks with no improvement. Do you think the damage is permanent? I'm desperate to fund a doctor who has any information on this. Everyone just says hopefully it will improve over time but nothing definitive,
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I apologize for the spelling errors. 2 neurologists and an ENT
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You should have sued that dr. He didn't seem to care at all. For the person still suffering from nerve damage, you can take Vitamin B6, I believe it was B6. It's one of the B vitamins and it helps nerve problems. I had an issue with an extraction where I had a bit of numbness and difficulty talking. I took the B vitamin because I read about people using it for this and it really helped. It went away a few days after I took the vitamin.
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Hello, I have practiced dentistry for over 24 years now and from what I have read in this discussion is that the injection was actually given into a blood vessel causing the excruciating pain. Very often the Lidocaine has epinephrine added to it to lengthen the duration of the anesthetic. However, if injected into a blood vessel it triggers an epinephrine cascade in the vessel, feels like fire and is very painful. Additionally an injection hematoma occurs and the vessel swells causing more prolonged pain and discomfort. When an injection is given we aspirate, meaning to draw back on the syringe, to make sure that we are not in a vessel. This does take time to resolve itself, and looks like what had occurred along your timeline. Cold packs initially and sometimes placing the patient on a Medrol dose pack relieves the swelling and symptoms. If the injection were into a nerve you would know it at that very instant and I am sure that the doctor would have moved the needle to aleviate the pain. This does not sound like an allergy to lidocaine or even a preservative in the anesthetic since you have been injected with this before. It sounds like a poorly placed injection.
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Thank you so much. This is very helpful. I just took down pictures of my partial paralysis, but if you think it would help, I would repost them.
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No need to repost the pictures. I'm sure that most all of your symptoms have disappeared by now and you are not in any pain presently. I hope all is well.
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Had Restylane injections 3 years ago, along with Botox and I loved the result. I had deep jowls and it completely got rid of them and they've still never come back as deep as they were. I will do it again this year, unless I opt for a facelift (Lifestyle Lift) instead.
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Hi,
I just mistakenly wrote my reply to Dr. Allen above, who helped KGB, instead of here,at the end of the comments. So I will ask it again. I had lidocaine with epinephrine injected into my mouth area, followed by what I was told, was Revanesse, 2 weeks ago. I am miserable, and frightened. I cannot pronounce p's. f's, v's, and consonants put together, like "th" etc. The doc said I have nerve damage, but it was due to MY reaction to the lidocaine with E. I think, of course, that she hit a motor nerve with the needle. My biggest fear is how long this could last. My life is at a screeching halt, as I'm so insecure to talk, and my mouth looks funny and distorted when I do. Is there anything at all that can be done to speed up this recovery? I know nerve damage takes awhile to heal.
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Hi Joyce
I was terrified, as you can see from the pictures I was totally distorted, but I was back to normal about 2-3 months later, thank god. I would recommend seeing a neurologist or a facial plastic surgeon specializing in nerve damage- just so see if they think you have nerve damage that will heal on its own - which it likely will. Very scary, but it should go away gradually.
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I wouldn't listen to that "dancer" person. I'm not a doctor, but I do know that sometimes, even in the best hands, things can go wrong. Nobody's anatomy is exactly like somebody else's and it truly may not have been the doctor's fault. It's also true that almost nobody is allergic to lidocaine, which is why they use it and not older, less safe products. The long-term tingling sounds like something that happens when a nerve is CUT; I had the same thing occur after my brow lift. However, it doesn't make sense that it would happen on both sides.

I do think it's possible that you had a problem with the preservative in the anesthetic. The fact that you never had a reaction before doesn't mean that you never will. It's possible to take a drug all the time, and suddenly develop an allergy. I would go see the allergist, and try preservative-free lidocaine from now on.

You may just have some kind of physical issue that means you shouldn't have nerve blocks in this area. "Lip plumpers" don't work the same way that injectibles will, and you'll never have the same result. They simply irritate the skin and make it swell. I'd go get that second opinion, and lay off the injections, but I don't think it sounds, to me, like anybody screwed something up.
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This sounds familiar. I had a crazy rittenhouse square dentist screw up, big time, an anesthetic injection in my mouth near the back teeth along the jaw line. It hurt like hell and I had to grab her hand because she was ignoring my groans and body language.

I could not open my mouth, without intense pain, for about 4-5 months.

I figure that no one is perfect and crazy me I went back to her again and she gave me this freaky, weird diatribe, psycho passive aggressive, directed against me but talking about aggressive middle aged women! I should have sued her ass.
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I believe it was all due to the dental block. Immediately there were big knotts on either side of my nose, and pain. I have never had that happen and I have been getting fillers for 6 years. A new girl injected it. Maybe she hit a nerve, it almost seemed like she put too much in too fast, but I dont know! They never gave me a recall or anything.Im not planing on using this office anymore! =( btw, The puffiness is still there especially in the morning. I guess maybe another month and I may be all better?
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I hope so! It took me about 3 months to recover fully - regain full feeling and have no funny paralysis. I'm sure you will fully recover if you're making progress now. Do you have pictures of your "after" experience?
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Also, was the "new girl" a Doctor or a nurse or PA? A ton of Doctors on this site have said that if a doctor lets a nurse or anyone else do their fillers, to RUN!
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Hi guys nearly 8 weeks now and the numbness is gone, but some of the weird face puffiness has remained, which turns my nose up a slight bit. In other words, STILL not back to normal. Just thought Id post an update! How are you girls all doing now?
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Hi! I'm back to normal. It was pretty scary how long it took, Probably 2 1/2- 3 months to fully recover. Did you say it was the dental block? Did your doctor ever give any explanation at all?
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You were more beautiful before the shots. There looks to be a lot of swelling.
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I know, it was awful.
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Yeah I would bet (obviously I'm not a doctor) that what happened to me happened to you. If you want to email a picture my email is kgbusse@hotmail.com. I was numb on a part of my lip and nose for about 2 months!! but luckily it is back to normal now.
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The same thing happened to me. I had done restylane and juvederm before without anesthesia, just ice. It was not bad. I am not overly sensitive to pain and it only lasts a minute. This was a new lady and she was very concerned about the pain. I told her repeatedly not to worry about it and that I did not need a dental block, but she insisted that the lips were very sensitive, and not wanting to argue, I thought, who cares and let her do it. Now, one week later, I am still numb on both sides of my nose and am swollen at the bottom of my cheeks like I have cotton balls in my mouth. I've been canceling all my plans and don't want people to see me. I looked good before. This was such a huge mistake and I emptied my bank account. KGB, would you post a picture of how you look now? You are so beautiful, I hope we all learned to appreciated ourselves the way we are more rather than risk our faces. (That said, I will continue to use botox judiciously between my eyebrows for a long time to come because I love how it takes away the anger creases without changing the way I look.) LOL
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