Nerve Damage After Cheek Lift

I had a cheek lift 6 weeks ago. I can't smile on my right side, and my right eye is very dry it stays open more then the left one I need to use eye drops. The doctor said there was no nerve cut but there is nerve damage. What does that mean? and how long does it last? Is is common? or did the surgeon make a mistake?

Doctor Answers 9

Likelihood of nerve damage after a midface

Midface lifts can be performed through the lower eyelid or through discrete incisions hidden within the hair located in the temples. The former approach is associated with more complications such as eyelid retraction (pulldown or ectropion) due to scarring dress and possible inexperience.

One must understand that there are two types of nerves a surgeon may encounter during normal facial surgery-Sensory nerves (which convey temperature, pain, touch, etc. and motor nerves (which govern muscle action). The nerve damage you describe which would hinder your ability to fully smile is related to motor nerve damage. The only nerve that is essentially encountered during the normal performance of an endoscopic, subperiosteal facelift is a sensory nerve(The infraorbital nerve). If you are unable to smile, this may be related to swelling, actual muscle trauma (Which fortunately, is usually temporary) or poorly performed surgery. Additionally, the surgeon may elevate and support the soft tissue of the cheek with sutures instead of the dissolvable Endotine device. The sutures are placed within the undersurface of the soft tissue of the cheek which may damage or lasso a muscle or nerve. This is the reason why I have long since abandoned the use of sutures during mid facelifts.
Of course, you should return to your surgeon and ask him for details and a prognosis. Most of these problems that you described will get better over time

Los Angeles Plastic Surgeon
4.6 out of 5 stars 52 reviews

Depends on the surgery you had..

I am sorry to hear about your frustrating problem. There are many different procedures that fall under the category of cheek lift. If you had a sub-periosteal mid face lift from a temporal incision, temporary nerve weakness is not unusual. Typically this is a stretch injury and the nerve recovers in several weeks. If it is going longer than that it may take up 6 months for full recovery.

If the nerve was severed the damage may be permanent but you won't know until you have given it enough time-usually 6 month but you would want to wait a year to be sure. In the mean time protect your eye with lubrication and get checked out by an Ophthalmologist. Hope this helps.

Ivan Wayne, MD
Oklahoma City Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

Nerve Damage after Cheeklift

When you say you cannot smile I assume you are describing limited movement of your eyelid with normal motion in your lower face and mouth. If an incision was made in the lower eyelid, there may be temporary weakness of the muscle of the lower lid. Excess skin removal from the eyelid can also cause this problem. Swelling of the conjuctiva (a superficial lining of the eye and eyelid) will interfer with lid closure. If the incision was made in the temporal scalp, facial nerve injury is rare but possible. Request an opthalmology consultation. At present. it is very important for you to have thoughtful evaluation and treatment to avoid injury to your eye.

Richard W. Fleming, MD
Beverly Hills Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

Nerve damage

The key is what was the technique used for the cheeck lift.

Most nerve nonfunction after surgery is teporary, some are permanent. Your most important part right now is to protect thee eye from drying and infection. Consult a good ophthalmologist, Consider suture tarsoraphy.

As for nerve returning to function wait another 6 weeks if the nerve does not come back in 12 weeks then see a neurologist for testing of the nerve.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Nerve damage after cheek lift

Sorry for your issue. Usually this complication after cheek lifting is self limiting, and corrects over a few months but I would recommend a second opinion to alleviate your concerns. At worse if you do have nerve trauma or injury a nerve conduction study can be ordered.

From MIAMI Dr. B

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

Nerve damage after a cheek lift.

It is probably not the type of nerve damage one normally thinks of, but rather small nerves to the muscle of the lower lid. Also if too much tension is placed on the lid it can get pulled down. Also, swelling of the lining of the eye can make it appear that way. The eye drops may be for that swelling(chemosis) which can take 2-3 months to go away. See your surgeon and if you are not satisfied, get a second opinion from an experienced cheek lift surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Cheek lift and nerve damage

I am sorry to hear you are having problems after your cheek lift.  I'm not certain how your cheek lift was performed since you do not indicate if it was through the lower eyelid or an incision in front of the ear.  No matter how it was performed there is always a risk of injuring a nerve when any invasive procedure such as a cheek lift is done.  Sometimes a patient can have facial paralysis such as you are experiencing due to swelling at or near the involved nerve and if this is case you should see improvement in the condition over time. 

It may take any where from 6 months to a year for the condition to resolve but you should see improvement as time passes - it may be so minimal that you are not seeing it in the mirror every day but you will eventually see your lip begin to raise and the pulling of your lower eyelid begin to improve. My suggestion is to be patient (which I know is hard) and to continue to follow up with the surgeon who performed your cheek lift and follow his advice. 

Arnold Zweig, MD (retired)
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Cheek lift and nerve damage

Cheeklifts, properly done, have revolutionized lower eyelid surgery.  They can prevent the pulled down or rounded appearance that affected so many blepharoplasties done in the 80's and 90's.  However, cheeklifts, particularly subciliary cheeklifts, are technically difficult and not for every surgeon.

Cheeklifts done through the lower eyelid have good ability to improve the eye-cheek junction, but involve a risk of damaging small nerve branches to the orbicularis muscle.  We have adopted minimal dissection techniques now to minimize this possibility.

Also, work on the orbital septum increases the risk for pulling down of the lower eyelid, temporarily (usually) or permanently.  All our cheeklifts now avoid any woirk on the orbital septum.

Obviously you would not want to do Botox in the crow's feet around the time of a subciliary cheeklift, since this will further weaken the orbicularis muscle and cause sagging of the lower eyelid.

In any event, you should be in close contact with your surgeon to get you through this period.  Taping and massage may be necessary.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Right smile affected from a midface lift

Could be swelling causing problems smiling but it could be nerve damage or injury.  The middle part of the face is the most likely to have a full recovery from an injury like this. But you could have some synkinesis issues, ie when you blink you move your mouth unconsciously.  6 weeks is early and it could take up to 6 months or longer for your nerves to grow back. Midface lifts are fraught with issues. Fat injections are the way to go to rejuvenate the middle part of the face.

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 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.