6 Weeks Post Facelift: Right Side Palsy - What Can I Do?

43 Days After Mid face lift. Right Side Palsy, Can't Smile, Eye Won't Blink.

Surgeons Said Should Recover..may Take Months. Getting depressed. Eye tearing


Doctor Answers 17

Face Lift with Facial nerve injury

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I sympathize with your anxiety over your post operative facial weakness/paralysis.

Most important is the immediate management of your  eye tearing. Your eye tearing can signify corneal exposure from the incomplete eye lid closure. I would suggest you consider seeing an Ophthalmologist to evaluate and manage this symptom.

There are many methods to performing a MID FACE LIFT. Since the damage to the nerve involves the eye and mouth it was unlikely an endoscopic procedure. As the other Physicians have noted these injuries are usually temporary and take time (3-9 months) to improve. 

The degree of injury can be determined by doing a bi-polar nerve stimulation test using a simple nerve stimulator. If the nerve stimulates it is still intact and has not degenerated. If it stimulates at a low level function may return soon. If there is no response to stimulation the nerve has either degenerated and function will take 6-9 months to return or it could be interrupted and movement may not return.

Physical therapy rarely has any benefit

Hopefully you and your surgeon can work through this situation together and have a successful result.


Naples Facial Plastic Surgeon

Face Lift and Facial Nerve Injury

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I'm sorry to hear about your diffuclties recovering from a facelift.  It is not uncommon to have temporary facial nerve injury following a facelift; in fact, this happens in about 1% of patients. 

Fortunately for you, facial nerve palsy and facial muscle weakness following a facelift is almost always temporary, with full recovery by 3-6 months.  The injury to the facial nerve is usually secondary to stretching or bruising and is unlikely to require futher surgery for repair.

The symptoms you are having, such as asymmetric smile, tearing, and difficulty blinking, are not surprising given the injury.  If the asymmetry really bothers you, you could ask your plastic surgeon to give you a little botox on the left side of your face.  This will temporarily weaken a few of the facial muscle on the left side of your face, making you a little more symmetric while the right facial nerve recovers.

The most important thing you can do, however, is to be patient and follow up routinely with your plastic surgeon.

Jaime Perez, M.D.

Face Lift Specialist in Tampa, Florida

Plastic Surgery Center of Tampa, Florida

6 weeks after midface lift

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Although it is hard to tell without seeing your pictures what you are describing is likely going to improve over months (6-12).  In the meantime there are measures to help you with your eye tearing that your surgeon can discuss with you

Facial Palsy 6 weeks after Fcelift requires expert evaluation and treatment

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I am very sorry to hear of your difficulty. It is true that the majority of Facial Nerve injuries causing facial weakness after Facelift do recover. However certain steps should be taken to intervene in the process to increase the chances of a successful recovery.

First ask your doctor is he/she will consult a Neurologist to determine the exact extent of the injury. It sounds as though 2 branches are injured-the Zygomatic Branch to the eye and the Buccal Branch to the mid face and mouth. Hopefully the Marginal Mandibular Branch to the lower lip is not also injured.

Secondly, it is very important that your weak eye be supported so that it can cover the eye adequately to keep the eye moist and avoid drying. A temporary stitch called a Temporary Tarsorraphy is a simple one stitch method to accomplish this. If upper lid closure is a problem a small gold weight can be placed into the upper eyelid to help closure.

Nerves heal very slowly about a centimeter or 1/2 inch a month. While this healing takes place the muscles that are paralyzed can atrophy and become weak.

I would use DC Electrical Stimulation to contract the muscles during recovery. This is controversial as many say this does not help, however I have seen this technique work for several people over the past 25 years.

Consult your doctor. The DC stimulator can be obtained from Med Labs in Goletta California. You will need some instructions on how to use it.

Good luck

Face Lift

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 At 6 weeks, your nerve may be bruised. You may want to get another opinion from a Board Certified Plastic Surgeon to evaluate your face and provide you with another opinion.  Too many opinions can be a problem so avoid that pitfall.  Stay in touch with your surgeon and ask for more information on the progress thus far.

Palsy and eyes not blinking

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  You have already gotten wonderful (free) advice on this forum.  I would like to add that while the eye is not closing or blinking properly, I recommend that you make certain that you are keeping it well lubricated with artificial tears and ointments.  IMHO, I am not sure that you even need another opinion.  Your doctor is right in that it almost (not 100%) will improve with 6-12 months of healing.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 138 reviews

Facial weakness after Face Lift

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  At 6 weeks, this is cause for concern and you should see a neurologist for facial nerve stimulation as well as an opthalmologist for proper eye lubrication and protection to avoid corneal ulceration and damage.  The nerve function may return and or improve over the next 3-6 months but you would still want to protect your corneas during that period of time.  Hope this helps.  In the meantime, you might consider tryiing to move your face and close your eyes to help stimulate the facial nerve branches.  Facial nerve injury, during a Face Lift is uncommon but it can occur.  Hope this helps.

Facial Nerve Issue After Mid-Face Lift

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The question describes as facial nerve palsy after a mid face lift.  The incidence of neuropraxia is higher in a subsperiosteal mid-face lift than it is for a SMAS based Facelift (jawline, neck).  The good news is that the majority of neurporaxias resolve spontaneously; 45 days is still well within the window where recovery is possible.  The biggest concern you have right now is inability to close your eye.  I would use artificial tears (Refresh, systane) liberally, apply a thicker form of ointment at night (Refresh PM, lacrilube), and even tape the eye shut while sleeping until function recovers.

Eye tearing

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43 Days After Mid face lift. Right Side Palsy, Can't Smile, Eye Won't Blink.

Surgeons Said Should Recover..may Take Months. Getting depressed. Eye tearing

I have read all the responses and they are all correct. bottom line is almost everyone gets better without intervention.  I am a little concerned that you did not describe a little flicker of recovery noted yet. Also I am worried about exposure of your cornea especially at night. you should be taping at night using onitment and drops liberally and see an opthomologist to examine your cornea. a temporary tarsorraphy suture (partially closes eye for a while) may be needed. a second opinion is reasonable if you are uncomfortable. ask your surgeon for a recommendation. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Face Lift and complications such as Nerve injuries

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Well I can tell the fear and trepidation in your voice. This is a very sensitive subject and requires handling with the utmost in care. The word of the day is reassurance, reassurance, and reassurance. Most all injuries of this type are temporary. I just worked one of my own patients through a difficult period with a similar situation and at 3-4 months we were fine. Its very doubtful that the nerve was actually cut. Sometimes as the surgeon injects some of the numbing medicine a nerve can be accidentally injured. Stretch injuries are also apart of a dissection if the surgeon is really trying to extend the pull and give you a nice result.  A super close relationship, many visits to just talk, and a sense of hope and compassion will get you through. good Luck.

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.