Chances of Disfigurement from Facelift?

I will have a Facelift to have a cyst removed from near my jaw. How likely is it that a nerve will be touched making my face asymmetric?

Doctor Answers 15

Facelift Disfigurement

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Question: Chances of disfigurement from Facelift?

Answer: There are potential complications and problems associated with any surgical procedure, cosmetic or otherwise. The types of problems and complications pertain to the type of procedure performed. For example, potential problems that may be associated with facelift surgery are different from those associated with gall bladder surgery. True disfigurement from a facelift implies injury to the facial nerve that supplies the facial musculature.

Today, in the modern era, with the advanced training and skills of most facelift surgeons, injury to the facial nerve is extremely uncommon. Like all other surgical procedures, a facelift should be performed in a methodically diligent manner by a well-trained, knowledgeable and experienced surgeon.

Chance of disfigurement after facelift

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With an experienced facelift surgeon performing a facelift, the chance of a permanent nerve injury is probably around 1% or less. If a small superficial cyst is removed in the process, this risk should not increase.

If your doctor is removing a parotid tumor, the chance of a nerve injury is higher, particularly if the tumor is malignant or widespread. The parotid gland has two lobes which are literally separated by the facial nerve, so great skill is involved in removing parotid tumors successfully.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

Can I be disfigured from a facelift?

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It is very rare for an experienced facial plastic surgeon to injure a nerve or cause disfigurement while performing a facelift. I'm not certain what you are referring to when you say that you are having a cyst removed from your jaw line. If this is a tail of parotid mass (salivary gland mass near the jaw), then the type of surgery you would need would entail a parotidectomy with a facial nerve dissection. In experienced hands, it is very unlikely that you would have permanent paralysis. There is a chance that you could have facial nerve weakness that can last for several months which is a result of retracting the nerve in order to gain exposure to the mass. 

I would need more information on what the cyst is before speculating on possible complications.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon

Facelift Approach and Cyst Removal

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A facelift approach can be used to access tumors of the jaw, parotid and face.  A typical incision to access this is called a Blair incision which goes straight in front of the ear and then along a crease in the neck.  A facelift approach involves an incision behind the tragus of the ear (see attached video) and into the hairline.  

In known benign tumors, patients can have a simultaneous lift as well.  This serves two purposes, when a parotid tumor is removed their can be loss of volume near the angle of the jaw.  The lifted tissue can help to fill in this area.  

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 177 reviews

Disfigurement from a facelift is exceedingly low

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A facelift is not done to remove a cyst from the jawline. A facelift is done for aesthetic enhancement, which is to tighten up the jowls, remove neck fat, tighten up the neck muscles, the facial muscles, and has got nothing to do with a cyst on the face. During the facelift operation in experienced hands, the chance of facial nerve paralysis is exceedingly low. We have never had a permanent facial nerve paralysis in our practice in over twenty years.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Asymmetry Secondary to Facelift

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In experienced hands nerve injury causing facial asymmetry after a facelift is very rare. The risk of nerve injury with cyst removal depends on the location of that cyst on the face and the depth of the lesion. Your surgeon will give you a more specific answer.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 43 reviews

Higher risk with Parotid gland surgery than with Facelift

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Hi Atoric,

It really depends on where exactly your cyst is:

1. Parotid gland cyst : if it is here than the risk is higher than with most types of facelift surgery. This is because the facial nerve travels and branches through the parotid gland. In order to remove the cyst, portions of the gland may need to be removed in order to do so. If that is the case then the surgeon will most likely dissect out and identify the facial nerve branches - while this may sound like it puts the nerve at risk it is actually safer to see the nerve than not to see it when parotid tissue is removed.

2. Cyst is superficial to the gland : in this case the gland does not need to be dissected and the facial nerve will be left alone. This approach is essentially similar to a facelift and the risk of nerve injury is considered to be less than or equal to 1%.

I think you should use the good information here and discuss in detail with your Surgeon what exactly the game plan is - when everyone is on the same page it leads to smooth sailing!

Take Care,

Dr. Kamran Jafri

Kamran Jafri, MD
New York Facial Plastic Surgeon

The risk of nerve injury in a facelift is very small

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The risk of nerve injury in a facelift is very small; however, having said that I have seen it occur in the hands of many surgeons who do not perform a fair number of these procedures. Typically a facelift is not done to remove a cyst. If it is a parotid tumor near the jaw as it maybe by your description, then the facelift approach is used to remove this type of tumor. However, when you remove a tumor or cyst around or near the facial nerve, the risk of nerve weakness increases to about 10 per cent even in the best of hands. Generally, the weakness recovers over time depending upon how much the nerve may have been stretched during surgery although on some occasions some weakness may be permanent. I hope this information helps.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Nerve damage from facial cyst removal

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THis sounds quite unusual and most surgeons would not typically perform a facelfit to remove a cyst. They may use a facelift approach to remove parotid tumors which can impinge on the facial nerve. However, in the hands of a skilled surgeon, this should be quite rare.

Discuss your fears with your surgeon so that they may provide better counsel.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Not unusual to approach a neck cyst with a face lift incision but this is not a facelift

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Dear Atoric

There are a number of reasons that facelifts can cause "disfigurement." Permanent injury to one of the branches of the facial nerve is just one of the causes. However, a cyst along the jaw line is not a medical diagnosis. Cysts can have various causes. A significant concern with these cysts is their relationship to branches of the facial nerve. When these structures are in close proximity, removal of the cyst can cause permanent damage to the motor nerve and long term or permanent facial weakness in the distribution of the nerve.

If the cyst is the primary reason you are having surgery, then you are not in fact having a facelift, you are having cyst removal with possibly an incidental facelift. My best advice is to be most concerned about the ability of the surgeon to resect the cyst. Performing a facelift does not place as high a demand on the anatomic skills of the surgeon as does removal of the cyst. As facelifts involve standard planes, one might find a well established surgeon with a good reputation who may not have the skills needed to resect such a cyst.

Conversely, it is propable that a surgeon with the skills to resect the cyst and avoid nerve damage is likely to have the necessary skills to perform a facelift. I would look for a surgeon with a large body of experience operating in the neck for lymph node dissections, tumors, thyroid abnormalities etc rather than say a famous facelift surgeon.

Hope this helps.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 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.