How common is lip palsy after a lower mid facelift?

Question

I have read a few reviews recently in which the patient has suffered from lip palsy from a lower face lift. How common is this? Is it possible it can be permanent?

Pejman Aflaki, MD · Answer

Lip palsy or permanent dysfunction of other facial nerve branches is very rare. Rate of injury to facial nerve branches is close to zero in experience hands. It's something that your surgeon should discuss with you.

Michael I. Echavez, MD · Answer

It is not common to have a lip palsy after a lower face lift, but if it did develop, it could be permanent.  I would say a lip palsy after a lower face lift would be very unusual in the hands of an experienced surgeon.

Todd Christopher Hobgood, MD · Answer

Thank you for your question! Facial Nerve injury is absolutely a risk of any face lifting procedure and your selected surgeon should be sure to mention this to you during your consultation. Although the risk is low, especially when your surgeon is well-trained and has complete familiarity with the anatomy, it is not something to be ignored during the planning of any procedure. My best advice would be to meet with someone that has double board certifications in facial plastic surgery to discuss all goals, desired outcomes, and techniques used during the procedures being explained. I hope this is helpful to you!Be well,Dr. Todd Hobgood, MD

Anthony Youn, MD · Answer

Although an injury to the facial nerve during a facelift is possible, it is an extremely uncommon complication. If it occurs, the vast majority of cases are reversible. Best to discuss this with your plastic surgeon to get an idea of his/her experience. Some techniques may put the nerve at higher risk than others.

Andrew G. Silver, MD · Answer

Hello sandy7217,
Lip palsy after a facelift is fortunately very uncommon, assuming the procedure is performed correctly by a surgeon that understands the complex anatomy of the facial nerve. 
Nerve palsy can definitely be permanent, theoretically due to a nerve being cut in half. More often, the nerve is just stretched or bruised, producing a temporary decrease in function. 
Bottom line, uncommon, but potentially permanent. Feel free to ask your doctor what their experience with the procedure is.
Hope this helps and good luck!
dr. silver

William Portuese, MD · Answer

In our practice, we have seen temporary lip palsy after A lower face lift procedure on a few occasions. Not from a mid-facelift. In our practice, they have all resolved completely on their own since the nerve was stretched, however does take 6 to 8 weeks to resolve. This is more common when extensive neck rejuvenation surgery is being performed. The palsy is only on the lower lip, and is only evident when smiling.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts and Neck Lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  In the hands of a very experienced Facelift Surgeon, lip palsy should be extremely rare.  The nerve that operates the lower lip is a single motor branch of the facial nerve called the "marginal mandibular" nerve.  It has a very specific pathway below the jaw line before entering the lower lip muscles after traveling within the "marionette lines" or "jowl" are.  It is within that area or even more commonly off to the sides under the chin that this nerve can be injured (when a formal neck lift is part of the facelift procedure).   The nerve can be stretched, cut or injured with electrocautery unless caution and extreme care is exercised when performing an extensive tissue dissection in one of the two above mentioned "danger zones".  Additionally, over zealous liposuction within the "jowl" are may also injure the nerve.  Evidence of nerve injury is the inability to "depress" the lower lip (pout).  An injury can take months (up to 2 years) to recover while a complete nerve transection will not.  This is just one of the reasons that the minimally invasive SMAS facelift has gained popularity as it does not place this nerve in jeopardy.
  The presence of "jowls” is an indication of sagging facial tissues which are the primary indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
  Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.  This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, possible hair loss and months of recovery.  It is in this procedure that the marginal mandibular nerve would be at the highest degree of risk due to the extensive tissue dissection within and across the neck. I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.   I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.Hope this helps.

Robert E. Zaworski, MD (retired) · Answer

Lip palsy following a lower facelift is uncommon, but can be permanent which is unusual.   An excellent understanding of the facial nerve and its branches will lead to a lower risk of injury and less complications.

David Alessi, MD - Account Suspended · Answer

A lip palsy can occur after a lower neck lift and can be permanent.  Thankfully, it is unusual.  This is an area where experience counts.  An excellent understanding of the facial nerve and its branches will lead to a lower risk of injury and a better chance of a superior result.  Best wishes.

How common is lip palsy after a lower mid facelift?

Answers (9)

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