Loss of Facial Movement after Mid-Face Facelift (Scars around ears and sideburn area). Any suggestions? (photos)

12 days post op and has lost the movement in her right eye , right nostril and upper right lip. After multiple visits to the surgeon, his solution is to have her come back into surgery tomorrow for a short procedure that will entail clipping a "deep stitch" that is supposedly hindering the nerve that operates that part of the face. She's nervous and freaking out a lot, and I've read up on it a little. Just curious if this seems like a good solution or if it's just a hail mary from the surgeon?

Doctor Answers 17

Paralysis May Persist for 6 Weeks

Thank you for your question. It's uncommon, but temporary paralysis after facelift surgery is not unheard of -- and when it does occur, it often resolves on its own after about 6 weeks. There are a number of things that can cause it, including the suturing of a small branch of the facial nerve, and without knowing the specifics of your facelift, I can't say for sure what's responsible. If your surgeon believes a significant branch has been tied up, then exploring and releasing early would be important to prevent permanent facial nerve damage.

Toronto Plastic Surgeon
4.8 out of 5 stars 59 reviews

Too much surgery too soon!

 From your description it appears that the facial nerve might have been stretched or cut. I would not recommend going back and re-exploring the area as it may create more damage. The facial nerves in the midface are very small and very difficult to actually identify.  The Doctor Who did this should explain to your friend clearly what his intention is and what the expectations are. At this point it appears that the facial nerve is not working well and as I said before it could be a cut or stretching of the nerve. Waiting might be an option however if he feel strongly that  his sutures is compromising the facial nerve it would be wise to take it out. 

Carlos Wolf, MD
Miami Facial Plastic Surgeon
4.9 out of 5 stars 60 reviews

Facial weakness following midface and facelift

Temporary facial weakness is concerning but can definitely occur following facelift and mid facelift surgery.  The surgical procedure involves dissecting close to the motor nerves of facial expression.  If suspension sutures were used then these sutures can pinch the nerves.  More commonly and fortunately is that the facial nerve was inadevertantly touched during the facial dissection and it has only temporary weakness that should resolve spontaneously.  The decision to go back into the face for nerve exploration or to cut the suture is one only your surgeon can make as they are the ones with knowledge of the surgical procedure they used to perform your surgery.  I might suggest waiting a bit longer.  If there is still no recovery then a nerve conduction study can tell you if the nerve is recovering or not.  

Philip S. Schoenfeld, MD, FACS
Chevy Chase Facial Plastic Surgeon
4.6 out of 5 stars 23 reviews

Loss of Facial Movement after Mid-Face Facelift (Scars around ears and sideburn area). Any suggestions?

It is still early after facelift surgery and if the nerve is going to recover you should start to see some movement return within the first 6 weeks after surgery.

It is always best to follow the advice of the operating surgeon.  I am assuming that the surgeon believes that AL SMAS plication suture may have compressed the facial nerve.

From your description of weakness it is likely that the buccal branch of the facial nerve was injured.  The positive aspect of a buccal branch injury is that it is freely anastomosing with the multiple branches and return of function is quite common.

However I would suggest that in addition to seeing her plastic surgeon she also consult a neurologist to clearly localize the point of injury.

If the weakness persists past 6 weeks then a trial of DC (direct current) muscle stimulation to keep the muscles from atrophying may be indicated.  The EMS DC muscle stimulator made by Med labs in Goleta California can be helpful.

Loss of Facial Movement After Midface lift

Based on your description, it sounds as if there there may be some degree of swelling to the zygomatic and buccal branches of the facial nerve.  In situations of a subperiosteal midface lift, the buccal and frontal (forehead) branches are most at risk due to the proximity of dissection to these structures; the zygomatic branches are theoretically less at risk.  Usually, this is a process of inflammation and not a situation of having nerve branches cut.  I am not your Surgeon, and this does not represent medical advice, but should a scenario arise in a patient of mine, I would not bring you back to the OR so soon.  Re-exploration at this time will be a more difficult case and could compound the problem with more inflammation.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 81 reviews

Get another opinion

Was your face functioning normally with normal movement until day 12? Was it a sudden onset of paralysis starting at that date? Answers to these questions make a difference in your decision making?
i have not seen a stitch cause constriction and paralysis. It's best to get evaluation and another opinion from a board certified facial plastic surgeon. It may be better to wait depending upon physical evaluation.

Brian K. Machida, MD, FACS
Ontario Facial Plastic Surgeon
4.1 out of 5 stars 22 reviews

Facial nerve injury post facelift

If the eyelid and the corner of the mouth do not work, there is some injury to the superior & inferior divisions of the facial nerve.  I have never seen a constricting stitch that would be placed so deep that the nerve would stop functioning.

If the nerve worked immediately after surgery I would recommend against further surgery.  It is unlikely that a stitch was placed so deep that it would contract the nerve.

I think a test to check the continuity of the facial nerve with a facial nerve stimulator would be in order.  You may have Bells Palsy which would not be repaired with surgery!

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.7 out of 5 stars 80 reviews

Exploration of the nerve is reasonable under these circumstances.

As your surgeon knows exactly what was done and where the sutures were placed it seems reasonable to re-explore the area.  Releasing the constricting stitch, if this is the cause, will help toward correctly your problem.  If a nerve was cut, the time to heal would be several months as the nerve regenerates.  Best wishes.

Neuropraxia after midface lift

It certainly could be a compressed nerve from a stitch, but as others have mentioned it could also be simply a bruised nerve or even cut during surgery.  Regardless of the particular cause, complete recovery may take quite some time.  Identifying the issue at hand and the surgeons course of action is reasonable. I know how stressful this can be, but keep a good attitude. Healing can take some time and it sound as though she chose a proactive surgeon who is making sure to take good care of her.  Best of luck.

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 9 reviews

Deep stitch issue

This could be trauma related to a cut nerve, a bruised nerve or a compressed nerve from a suture. It may be difficult to tell which suture might be causing this even if this is the cause. It might also take months for this to improve if this was the cause.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

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.