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.


22 Comments

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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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?

 **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.

21 Comments

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.
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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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 times
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