Crooked Smile After Bichat Pad Removal, Is It Permanent Damage? (photo)

Question

I did a removal of the bichat pads 8 months ago. Even after all this time, my smile is crooked. Greatly reduced the fat of the face, but the right side of my smile does not raise (upper lip). After the surgery, this side of my face was incredibly more swollen than the left. I fear that the surgery has caused permanent damage. What can it be?

Ali Sajjadian, MD, FACS · Answer

Hello Lelele,

	 

	Thank you for sharing your photographs that show clearly an injury to right buccal branch of your facial nerve.

	 

	During the surgery, the buccal nervous branch is spotted and carefully protected to prohibit any facial paresis from taking place. In your case, the buccal branch has been insulted.

	 

	Recovery could happen as far as the insult is not severe and the growth of the branches is motivated and not delayed.

	I encourage you to keep your surgeon in the loop and to seek a well experienced surgeon for consultation as well.

	 

	Aesthetically, relaxing the buccal muscle on the left side could help and it is achieved by Botox injections until the recovery on the right side takes place.

	 

	Best of Luck to you.

	Dr. Sajjadian

John Mesa, MD · Answer

Facial nerve damage is one of the risks of buccal fat removal. If a facial nerve is affected during the procedure it translates in either a temporal or permanent weakness of the facial muscles controlled by the nerve. It might be possible to perform diagnostic studies like Electromiography to determine the state of the facial nerve in question.

Sam Naficy, MD, FACS · Answer

You do have weakness of the right buccal branch of your facial nerve. Hopefully this will continue to improve with time. In the short term use of Botox to relax the opposite (left) side can help make your smile more symmetric

Stephen Prendiville, MD · Answer

Unfortunately, this pictures shows what appears to be a right buccal branch paresis (weakness) after buccal fat pad removal. This is a rare, albeit real complication associated with the procedure. At 8 months, there is still some chance this branch(es) of the facial nerve will recover. I would recommend close follow up with your Surgeon and possibly a consultation with a Facial Plastic Surgeon in a local academic center who has an interest in facial nerve recovery/ reanimation.

Karan Chopra, MD · Answer

The Buccal Fat Pad is deep in the face therefore it cannot be addressed with liposuction. Typically a small incision inside the mouth is used. In most cases, this can be easily extracted. In experienced hands a nerve injury is very unlikely but may occur if the dissection is difficult. Thankfully, this is typically temporary and should resolve within a few months. During the recovery after a nerve injury, botox to the other side can help create symmetry until your other side recovers. See an expert.

Raj S. Ambay, MD · Answer

Nerve injury is likely in your situation. However, it's prominency can only be determined over time. I recommend waiting at least 12 months to make a final determination. Please go back and visit with your plastic surgeon.

Richard P. Rand, MD, FACS (retired) · Answer

The facial nerve branches are in close association with the buccal fat pad and it appears that you have had an injury there. Fortunately, there are multiple branches of the nerve in that region and they may still recover but at 8 months it is possible they won't. B complex vitamines and massage may help and visiting a plastic surgeon at an academic medical center who does nerve work would be useful.

Crooked Smile After Bichat Pad Removal, Is It Permanent Damage? (photo)

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