Subcision - can it damage the nerve that affects speech? What are my options? (photo)

Question

A plastic surgeon told me that subcision in the area I circled (in the pic) is too risky as it can permanently damage the nerve there that affects speech. (I.e. the Buccal nerve) Please advise if you agree and what my options are. I wanted subcision and filler but he also told me thay filler would migrate in that area due to smiling.

Steven F. Weiner, MD · Answer

I disagree with the advice you received. I do this area with subcision and filler all the time. I would get another opinion, Dr. Davin Lim, who is in Brisbane. If blunt cannulas are used for subcision, there is no risk to the facial nerve. I agree that using a Nokor needle could put this nerve at risk and is why I don't use this needle for subcision. Fillers would greatly improve the scars shown and I would place beneath the scar in the sub Q using the same cannula and then in the dermis with needles. Refyne or RHA 2 or 3 is a good choice.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Risks to be discussed in the CONTEXT of your planned procedure. Your surgeon will consent you accordingly. Broadly speaking risks in this area is extremely small as the plane of subcision is hypodermis (high SQ layer). Pranging the mandibular br of CN VII is much higher. Be guided by your surgeon - context of needle, NOKOR, Blunt Cannulas etc....etc...etc...
The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery.

Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits.

Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening.

The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types.

My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis.

All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.

Subcision - can it damage the nerve that affects speech? What are my options? (photo)

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Subcision - can it damage the nerve that affects speech? What are my options? (photo)

Answers (2)

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Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.