Facial Nerve Injury After Ultherapy

I had ultherapy 3 days ago. I immediately noticed minor weakness of left lower lip depression usually when I yawn or emulating a "denture smile". The mentalis muscle was spared since I can still pout so I assume this is either partial injury to marginal mandibular branch of the facial nerve or injury to the cervical branch of facial nerve responsible for partial innervation of the depressor anguli oris muscle. Will this recover? Has anyone else experienced this issue with ultherapy

Doctor Answers 3

Nerve weakness after Ultherapy

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Sorry to hear of your complication. This is very rare but has been reported.

Neuropraxia is a condition in which the nerve tends to "hibernate" after a traumatic insult and eventually wakes up.  This restoration may take weeks and from what I've heard there has been no permanent nerve deficit after Ultherapy.  Neuropraxia of the marginal mandibular nerve has spontaneously resolved within a couple of months or longer in all cases of the very few that have been noted. Good luck that yours takes little time to recover.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Rest assured - it will get better

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I'm so sorry you had this unfortunate event, it must be very distressing and worrisome to you.  But rest assured, I am confident that it will go away.  I have never had this happen in my practice, but it is possible in even the most experienced of hands.  It is an extremely rare side effect from the treatment, and I have heard of less than 5 occurrences in the world, but it can happen.  It typically lasts for only 2 weeks.  I have never heard of a permanent nerve injury, and I do not think it is possible if the treatment is performed according to protocol.  

Nerve injury can happen after treatment right along the jawline or on the chin - just on the inside of the "Marionette line".  These are the 2 locations where the marginal mandibular nerve becomes more superficial (closer to the skin surface).

Injury to the nerve can happen by 2 reasons:

  1. inflammation surrounding the nerve (local swelling compresses the nerve)
  2. Neuropraxia  (see Sunderland's classification of nerve injury, this is the very mildest form - type 1)

Keep in close contact with your physician and make sure he or she is aware.  A short course of oral steroids may be helpful, and you may want to inquire about this with your doctor.

Hope that is helpful to you and wishing you the very best.

W. Matthew White, MD
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 6 reviews

Recovery of function of the marginal mandibular nerve

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What you are describing is related to thermal injury of the marginal mandibular nerve and almost all described cases (as far as I know) have resolved over a course of several months. 

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