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

Question

43 days after mid face lift. Right side palsy, can't smile, eye won't blink. Surgeon said should recover…may take months. Getting depressed. Eye tearing.

Jaime Perez, MD · Answer

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

Sam Naficy, MD, FACS · Answer

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

Vivek Bansal, MD · Answer

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.

Lawrence Kass, MD · Answer

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.

Mike Majmundar, MD · Answer

I'm sure this is a very trying and frightening time for you. Facial Nerve Injuries during facelift surgery is very unusual and most likely this is a temporary injury. The most important function of the facial nerve is to protect the eyes. Consider seeing an opthalmologist to maintain the integrity of your cornea to minimize any visual problems. Nerves can recover as soon as 4 weeks or can take as long as several months. The most important thing is to remain optimistic and hopeful. Good luck.

Stephen Prendiville, MD · Answer

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.

Babak Azizzadeh, MD, FACS · Answer

Please make sure you see your surgeon regularly. You may also want to get an opinion from a facial paralysis expert. If you are in the LA area please feel free to schedule a consultation at my facial paralysis institute in beverly hills.

Frank P. Fechner, MD · Answer

It is understandable that you feel blue during your complicated recovery.

	You experiencing demage to branches of your facial nerve. The most vulnerable branch in midface lift surgery  (if the midface is approached through an incision within the temple hair or as part of a brow lift) is the temporal branch. This nerve allows you to raise your brows in addition to other animations around the eyes. It sounds like that you have injury to the buccal branches which are necessary for smiling.

	Your plastic surgeon will be in the best position to predict your outcome. These injuries are very rare. Most commonly though, they are the result of pressure or stretch which should lead to (full) recovery. Unless the nerve has been cut or severely damaged by other means (such as cautery etc), function will return.  How long that recovery will take depends on many factors but 6 weeks is just about the time where your surgeon may hope to see a little improvement.

	Make sure to maintain close follow up with your facelift surgeon.

Ivan Wayne, MD · Answer

I am sorry to hear about your problems following Facelift surgery. It sounds like you have a facial nerve injury, this can either be temporary or permanent. Fortunately most injuries are temporary, usually a stretch injury. I would have a frank discussion with your surgeon. You may also consider getting a second opinion from an Otolaryngologist, ideally a neuro-otologist. There are case reports of Bell's palsy at the time of a Facelift that are un-related to the surgery itself. Also, a neuro-otologist will be experienced in the treatment of patients with facial nerve weakness. You may additionally consider an evaluation by an Ophthalmologist to make sure your cornea is not at risk for injury. I hope this helps during this difficult time.

Philip Young, MD · Answer

This prediction is based on assuming the facial palsy is due to traction injury at a relatively far place from the origin of the facial nerve. The closer the injury is to the origin (brain) of the nerve the worse the injury. This may take up to 6 months to get better. If you are having some movement now the chances are better. You can always write me with any questions. We can do a phone or video consult! Wish you well!

	Thanks for reading, Dr Young

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

Answers (17)

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