Will Facial Nerve & Muscle Return to Normal? (Surgery Was 7 Months Ago)

Sorry to hear about the issue you experienced following surgery. What you describe are typical side effects of nerve damage. In general, nerve damage from a facelift can result in the following side effects:

1) Numbness of the face
2) Difficulty making certain facial expressions
3) Ear numbness
4) Drooping of facial features (mouth or cheek)

In general, most temporary nerve damage that occurs from a facelift will be resolve in anywhere from 6 months to a year. It may take longer for a complete recovery, but it depends on the patient and the circumstances of the issue. Typically, nerve damage to the buccal branch in the area of a midface lift is forgiving, and a most patients have a complete recovery. I would recommend speaking with your surgeon to see what he or she advises. Thank you and I hope this helps.

Thanks for the question. First 24-48 hours after the operation face will be swelling. After 48 hours swelling will be decreases. Scalp area stitches are taken from the day 10. Final results may take 1 month. Patients can return to work after 1 week. The effect of gravity varies according to the aging speed and lifestyle but it provides an average permanent effect of 10 years. I wish you all the best.

This is a difficult situation to evaluate without photos. For one, it appears that your right side "over-activity" is a compensatory mechanism for the left sided injury.
I would review this with your plastic surgeon and neurologist. He may be able to do specific neurologic  tests to document where and, to what degree, the nerve may be injured.
Yes, there is hope! Try this...tap your cheek gently with your index finger, starting at your earlobe/face jct. and proceed towards the corner of your left mouth angle. See/feel if there is "tingling" at a certain spot- this may be the site of the injury to the nerve/muscle. Don't give up and get the neurologist  opinion. (There are some who deal with nerve injuries). Good luck! 

Unfortunately, nerve injury is possible during any surgical procedure, and the facial nerve could potentially be injured during some brow and/or face lifting procedures. It is possible to see continued nerve improvement for 12-18 months after nerve injury (or even longer in some cases), but as others have stated, seeing some improvement is a good prognostic sign, while not seeing any improvement at all would be a bad prognostic sign.
All the best,

First of all, I am so sorry for this unfortunate complication. Please remember that it can happen in the hands of even the best of surgeons.

There is definitely hope. The facial nerve can come back as late as 18 months. Having said that, it is a long road. You have to have a game plan. Here it is for you.

1. Physical appearance: Use make up and hair style changes to hide some of the left side. Work with a good make up artist.

2. Emotional issues: It is not easy to handle the present situation. Make sure you have plenty of emotional support. In these trying times you don't want any friends or family telling you, 'I told you not to do it'. Instead stay close to people who are positive. If you start feeling depressed make sure to get professional help.

3. Your Surgeon: Trust me your surgeon is just as worried as you are if not more. Stay in regular touch with your surgeon, preferrably in person not just by phone

4. Your Recovery: There is no way to expedite the recovery of your nerve but I always tell my patients to do facial exercises by making faces and moving facial muscles in all directions all day long. Also massage the whole face every night with a moisturizer. I prefer cocoa butter with Vit-E

5. Facial Appearance: Maximize the remaining facial appearance. Your surgeon can use some Botox to even out some of the asymmetries between right and left side of the face. Some fillers can be used to soften the deep grooves. These small things will add up to make the face look better.

6. Plan-B: Discuss with your surgeon about what to do if the nerve does not return.

7. No Rush: Do not rush into any procedures, take your time, do your own research.

My best wishes and warm regards.

Dr. J

Disclaimer: This answer is not intended to give a medical opinion and does not substitute for medical advice. The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case.

It is possible that you may have additional motor nerve recovery.  However at 7 months much of this recovery should have already taken place.  It is unrealistic to except further dramatic improvement.  You might consider evaluation by surgeons who specialize in facial nerve injuries.  The Cleveland Clinic has a well respect group for this.

In all likelihood, the injury sustained during your endoscopic midface lift was a paresis or weakening of the buccal branches of the facial nerve; the buccal branches are closely associated with the masseter muscle and dissection in this region has been associated with buccal branch injury.  Luckily, this particular branch has many branches and the chances for recovery are still very high. When a motor nerve like the facial nerve is injured, 12-18 months are generally the expected outer limits of recovery time.  The main question I would have is whether you are beginning to experience any initial recovery.  If function is trending toward recovery, the prognosis is better than if it is not.

   Buccal branch injuries tend to recover completely due to the cross innervation of those branches.  You will likely recover in 12 to 18 months.  I guess anything is possible, but probabilities are on your side.  Good luck.

Hi @AnnieGirl,



Thanks for your question. I suspect you have nerve damage to the left buccal and possibly zygomatic branches of the facial nerve. At this point you should have improved or at the least been assessed or followed for improvement. Possibly BOTOX on the right to make it more symmetric while you recover.



The Buccal Branches are the most commonly injured nerve branches during a Facelift but they are usually the least likely to be noticed because there are so many Buccal branches that they compensate for one another.  



The Buccal Branches supply motor control to many muscles including those for flaring the nostrils (Nasalis Muscle), and lifting the upper lip (Levator Labii Superioris).



There is still hope for recovery because once a nerve branch is cut, the muscle it supplies can last 18 months before it can no longer be salvaged. And the nerve branches regenerate at an inch a month. There is still hope for you to recover and I would seek out a plastic surgeon with experience in Peripheral Nerve Surgery to evaluate you and walk you through your options.



Best Wishes,



K. Chopra, M.D.
Johns Hopkins Trained Plastic Surgeon

Face, Body and Breast Expert

I'm sorry that you have had to deal with this problem, but there is certainly a lot of reason to be optimistic.  Severing of the buccal branch of the facial nerve is very unusual in aesthetic facial surgery.  More often, the nerve branches are stretched or inflamed after surgery from manipulation of nearby tissue.

The buccal branches of the facial nerve are numerous and often somewhat redundant, and therefore even if some branches have been damaged, others will compensate over time.  This does take time, however.  Patience in this situation is so very difficult, but very necessary.  

Your surgeon, in the meantime, may be able to provide some symmetry to your face by weakening the overactive side temporarily with Botox.  Be patient, and keep up the optimism- things will likely end up better than you expect.