Trigeminal nerve accidental nicks?

Question

In a face-lift, how close do you get to the trigeminal nerves? How often have you injured one? Is there a patient site available that can disclose these accidents so that we can better choose our surgeons?

Jose Telich, MD · Answer

Dear Courageous166412, thank you for your question!

During a facelift, the focus is primarily on the superficial muscular layers of the face, and great care is taken to avoid deep structures like the trigeminal nerve branches. Surgeons typically operate near sensory branches of the trigeminal nerve but remain in layers where the risk of direct injury is minimal. Accidental damage to major branches of this nerve is very rare in skilled hands, but minor temporary numbness is more common and usually resolves as healing progresses.

For reassurance when choosing a surgeon, look for board certification, experience in facial surgery, and patient reviews. You may also discuss specific nerve preservation techniques with your surgeon to gain confidence in their approach.

Safa Manav, MD, FEBOPRAS · Answer

During a facelift, surgeons operate near branches of the trigeminal nerve, particularly the mandibular and maxillary branches, but experienced surgeons typically avoid injuring these nerves. Accidental nerve nicks are rare but possible, emphasizing the importance of choosing a skilled surgeon. To find reliable information on surgeons and their track records, consult patient reviews on sites like RealSelf and Healthgrades, and check credentials through professional associations such as the American Society of Plastic Surgeons (ASPS).

Stephen Prendiville, MD · Answer

The trigeminal nerve is one of the largest cranial nerves, with both motor and sensory branches.  The main body of the nerve is located in the skull base and its sensory branches are divided into larger branches exiting the skull in 3 central locations, and much smaller branches which provide sensation to the lateral face.  The latter are the the small C-fibers that are divided when a facelift flap is elevated, accounting for the 6-12 month duration of numbness in the lateral face. This occurs 100% of the time during a facelift and isn't an injury per se: it is an expected part of the procedure. The central (supra-, infraorbital and mental sensory nerves) aren't in the plane of dissection of a SMAS based facelift but are encountered during procedures such as a brow lift and/or midface lift, chin implant

Donald B. Yoo, MD, FACS · Answer

Trigeminal nerve injury would not be a concern for facelift surgery as these nerves are not at risk during the dissection. Injury to the greater auricular nerve and the marginal mandibular branch of the facial nerve are the most at risk, so it's important to seek out an experienced surgeon with a mastery of the anatomy to avoid complications and to ensure the optimal result.

William Portuese, MD · Answer

The trigeminal nerve is nowhere close to the incisions or the surgical procedure so there are no issues related to that nerve when performing a facelift procedure

Trigeminal nerve accidental nicks?

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