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

I had an endoscopic brow/midface lift 7 months ago. It appears that the buccal branch of my facial nerve (on the left side) has been severed or badly injured. My mouth and upper lip are uneven and I am barely able to flare my left nostril, whereas the right side of my nose and mouth seem "overactive." When I speak and chew, my mouth slants downward and to the right. When I smile, my left lip hangs low on my teeth, and the middle of my upper lip is off center. Is there still hope for improvement?

Doctor Answers 10

Facial nerve injury following endoscopic brow lift and midface lift

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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.

Facial nerve injury after endoscopic facial surgery

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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.

Facial Nerve Injury

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I am so sorry this has happened to you. I hope this is helpful:

  • nerve recovery can still occur but you should now see slight improvement
  • Botox on the other side may help. It may even improve recovery on the injured side.
  • Unless your surgeon specializes in nerve injuries, I would also consult a Board Certified plastic surgeon specializing in nerve repair. If your nerve doesn't recover, you may need further surgery.

​Best wishes.

A very unwelcome outcome after cosmetic surgery.

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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.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Facial Nerve Injury

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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.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 104 reviews

Recover from facial nerve injury

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I am sorry you are suffering with this.

The buccal branch of the facial nerve fortunately is very robust, and has cross communications making a complete recovery, even at this stage a good possibility.  You should see most recovery by about a year, but you may expect to see continued improvement for up to two years.  You may want to ask about using a nerve stimulator to maintain muscle mass.


Recovery of Buccal Branch Facial Weakness After Midface Lift

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The buccal branch of the facial nerve has numerous cross-connections and has the greatest capability of full functional recovery of any branch of the facial nerve. It may take a year or more for the maximal recovery to be seen. Rather than an absolute number or endpoint what equally matters is the progression of the nerve recovery. As long as some improvement (no matter how small) is ongoing, the nerve recovery process is continuing.While it is a long time when you have to live through it, you have not reached a point where you are likely looking at the final result of how the nerve will ultimately function.

Facial Nerve Recovery

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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.

Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 126 reviews

Nerve damage and weakness after a facelift

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Nerve damage after a facelift can be very distressing.  Fortunately in almost every case of buccal branch damage there is full recovery.  This can take as long as a year to year and a half.  If the asymmetry is the most bothersome you might want to try some botox on the opposite side for balance.

Buccal Branch Injury and Midface Lift

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   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.

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.