After a necklift with lower facelift, can there be permanent nerve damage to my tongue?

Question

The tip of my tongue was numb after surgery, causing a lisp. I thought it was from too much anesthesia. It took four hours for me to come out of anesthesia and I was told I fought with the staff. It's been seven months and I still lisp. This is scary since I perform for a living. There is also a knot at the base of my left ear, which the surgeon says is a stitch. There was a large hematoma on my neck on that side after surgery. I'm wondering what could be the cause of my tongue problems?

Robert Kotler, MD, FACS · Answer

Dear Sironen;

It's hard to say why the tip of your
tongue was numb after surgery.  There are
some nerves in the neck that supply sensation to the face and neck, but
typically the procedure you had would not cause numbness in the tongue.  It may well have come from the anesthetic because a tube in your mouth may have pressed the tongue against the
teeth, although I am speculating.  My
recommendation is to discuss this with your surgeon and with the
anesthesiologist who did your case.  Four
hours is a long time to come out of the anesthesia, and if there was some
“fighting with the staff,” then maybe that was a factor; maybe you bit your
tongue or whatever, but again these are only educated guesses.

Regarding the knot at the base of your
left ear, there may well be a stitch underneath the skin and that will take time to absorb.  Your surgeon can
tell you whether the stitch was destined to absorb or whether
some “permanent” stitches were used, in which case stitch removal may be
necessary.

You certainly need to have a
re-consultation with your surgeon and go over every issue. And there is
nothing wrong with a second opinion. 
Consultation with an experienced facial cosmetic surgeon can be very
helpful and informative to you. Doing some more homework may help if you feel the need to get a second opinion.The time you spend will be worth it. You want to do cosmetic facial surgery right – the first time. The
most critical element of the process is surgeon selection. Ideally, you want a
board-certified surgeon, in either plastic surgery or head
& neck
surgery fellowship trained, who is highly focused
on the procedure(s) you want, who performs them at
least weekly and who has been in practice for a minimum of ten
years.

Websites are the
key to understanding various practices. You should see at least dozens
of before and after pictures, showing the changes in the procedure
you want. The most helpful
sites have a variety of graphics, including photos of how you might look one or
five or ten days after surgery. Look for detailed explanations of
all procedures. The site should answer nearly every question you have. Generally, the top
practices
have the thickest, richest and most informative websites. The dedicated doctor spends
much time building an educational website for your benefit.Today’s medicine
is an area of extreme specialization because medical knowledge doubles every 18
months, even specialists in a particular field of medicine select and
concentrate on just a handful of procedures, becoming extremely familiar,
efficient and adept at performing or delivering them. For instance, a
cardiologist knows all about the heart, but does not operate on them. A cardiac
surgeon handles heart surgeries but may ask a heart valve specialist to do
operations on heart valves. That heart valve surgeon has gone beyond being a
specialist and is now a super-specialist, which is a medical, (and not
advertising) classification. Likewise, a cosmetic plastic surgeon who
specializes in only four to seven facial procedures has become a
super-specialist in say, cosmetic and functional nose surgery along with a few
procedures of the face and neck.  The super-specialist is more likely to
have had a fellowship, an arrangement in which a younger surgeon works
at the side of a Master Surgeon for a year, concentrating on and performing
only a handful of procedures. The super-specialist works so efficiently,
healing is faster because less tissue is disturbed going in and coming back
out. The procedure is also more likely to be done correctly, the first time. IBest wishes,Robert Kotler, MD, FACS

Andrew Kornstein, MD, FACS · Answer

The one scenario I can envision is if you had sub-platysmal neck work, specifically to reduce or elevate a large submandular gland. Hematoma can certainly cause nerve injuries, usually temporary, if the surgical planes to the lingual nerve were opened at the time of surgery.A neurologist, MRI or Dr Dan Baker in NYC(an expert in facial nerve injuries---there may be others) may be able to further advise/help you

Clyde Mathison, MD · Answer

Tongue sensation comes from the lingual nerve, which is located underneath the outer aspect of the floor of your mouth and deep the mandible.  Injuring this nerve during a lower facelift would be very unlikely and difficult.  I would contact a local otolaryngologist (ENT surgeon) to have a complete head and neck examination to rule out other causes of lingual nerve abnormalities.

Vincent D. Lepore, MD (retired) · Answer

Although, it is very unlikely that a lower face lift would result in permanent nerve damage to the tongue, it is not impossible.  If you are concerned, I would suggest you seek out a local board certified neurologist to evaluate this problem.  It is possible that the tongue problem is not necessarily related to your surgery.  Best wishes, Dr. Lepore.

After a necklift with lower facelift, can there be permanent nerve damage to my tongue?

Answers (4)

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