Can Infraorbital Nerve Damage Pain from Restylane Be Permanent?

Question

I am about 1 week post Restylane injections. I felt a numbness all the way to my lip with the injection. Called ps and asked if nerve damage was possible. Nurse told me that is was not. The feeling came back about 6-7 hrs later in most areas. The next day I started having spells of numbness. This quickly turned into spells of intense pain and pressure. After a few days the ps did say it was nerve damage. I am being told that this is not permanent. Mentally it is taking its toll. Any advice?

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question. The discomfort will resolve. See a specialist in this region of the face (oculoplastic surgeon) for comprehensive evaluation if the pain persists. Good luck.

Kenneth D. Steinsapir, MD · Answer

It is very unlikely that this will be permanent. Having said that it is difficult to estimate how rapidly you will recover. If the sensation does not recover in the next week or so, it might take much longer for all of the sensation to return. I think it would be very understandable if you ultimately decided to find a new injector after this experience.

Steven F. Weiner, MD · Answer

It is possible for the infraorbitial nerve to be injured during Restylane injections. This is most likely to occur with needle injections. Unfortunately, there is not much that can be done to heal the nerve, just time. Permanent pain and numbness is rare but possible.

Jessica J. Krant, MD, MPH · Answer

If you are feeling numbness and pain that comes and goes from your cheek down to your upper lip after Restylane treatments, please do not underestimate this issue. It is possible, as you have heard, that a nerve branch can be irritated by being poked by a needle, or that there could be pressure against the nerve from the filler itself. Nerves that are poked or irritated will most likely settle down over weeks to months.

	However, there is a more serious issue I would like to warn you about--pressure against the artery or worse, injection into the vessel itself, which would cause blockage of blood flow to the same area. There is a neurovascular bundle that comes out of the infraorbital foramen in the cheek which contains a nerve and artery that travel together. Please see your injecting physician (not just speak on the phone to the nurse, as you have done) and make 100% sure there is no trouble with arterial blood flow, which can lead to devastating consequences.

Steven Wallach, MD · Answer

The infraorbital nerve lies a cm or so below the orbital rim in the midpupillary gaze. This is a common are of filler placement. Perhaps there was some compression from the filler? If so, it usually gets better. If not improving you may want hyaluronidase injected to dissolve the filler.

Can Infraorbital Nerve Damage Pain from Restylane Be Permanent?

Answers (8)