Nerve Issue After Lipo of Chin and Neck/Jaw Line

Question

After neck/chin lipo at what point should you become nervous or are certain things red flags? I am only two weeks out so I know it is soon but it's very hard not to worry. My lower right lip is "pulled up" if I smile with lips closed it looks normal but showing teeth, talking, laughing, yawning it's like my lip is "pulled up". Sensation is fine. If somethings only happens to 1 out of 1000 people I'll sadly be that one. Please help me understand what I can expect here & if or when I should worry.

Kenneth D. Steinsapir, MD · Answer

Weakness of the marginal mandibular branch of the facial nerve is well described after facial liposuction. It was once much more common due to the size of the cannula that was used. As cannula size has come down, the incidence of this injury has fallen off. You are extremely early from you liposuction. The nerve can be mildly traumatized and this can lead to a weakness on the side of the injury. Over the course of many more weeks, it is not uncommon to see these completely resolve. However, it is also possible that not all of the function will recover. I would definitely bring this to your surgeon's attention so they can worry about the problem with you.

Richard J. Bruneteau, MD · Answer

Although unusual, injuries to the
marginal mandibular nerve can occasionally occur during liposuction of the neck.  This nerve supplies the muscles that
move the corner of the mouth.  When
injured these muscles don’t function properly and this results in a distorted
smile.

During the procedure a liposuction
canula is repeatedly passed through the subcutaneous tissue.  This canula has the potential to damage
the marginal mandibuler nerve.  In
the majority of cases, the  nerve
is stretched or bruised, but rarely it can be transected. In most cases nerve
function returns with the passage of time, but loss of function may be permanent
when the nerve is transected.

In the majority of cases the nerve
is located above the jawline.  In a
small number of patients the nerve lies below the border of the mandible.  Under these circumstances the nerves
may be more vulnerable to injury during neck liposuction.

When this type of problem occurs
following liposuction, consultation with your plastic surgeon is
important.  It’s also important to
understand that the vast majority of injuries to the marginal mandibular nerve
resolve without treatment.

Vivek Bansal, MD · Answer

See a Board Certified Plastic Surgeon and be evaluated for nerve function. Also, swelling can cause some impairment of the nerve for several weeks, but nerve damage is a possibility as well. Thus, you need an evaluation with a Board Certified Plastic Surgeon who can offer alternatives.

Laurence Weider, MD · Answer

It is not unusual to observe some weakness of the muscles controlled by the marginal mandibular nerve after submental liposuction (liposuction under the chin). It usually occurs on one side resulting in an asymmetrical (lopsided) smile. The good news is that is is almost always temporary. It can take from a few weeks to a few months to get better. Botox can be used to even out your smile while you wait for the nerve to heal, but I would give it 4-6 weeks to see if the nerve will heal quickly.

Khaled El-Hoshy, MD · Answer

Most likely, you have weakness of the muscle that pulls down the lower lip &/or the muscle that pulls down the angle of the mouth. This is usually the result of trauma to the nerve supplying the muscles. It usually resolves within a few weeks. Permanent damage of the nerve can be another possibility, albeit very rare. I agree with my colleague who suggested a little botox on the opposite side to correct the asymmetry. I personally would advise waiting for 4-6 weeks to give healing a chance.

Barry L. Eppley, MD, DMD · Answer

One of the risks, and perhaps the most significant one, from liposuction of the jowls and along the jawline is injury to the marginal mandibular branch of the facial nerve. This can cause some weakness to the muscle that normally pulls down the corner of the mouth and lip. This will result in asymmetry of mouth and your description sounds exactly like what would occur of this happens. While it is not common, the good news is that it will be temporary. The small nerve branch has not been cut but just bruised or stretched. You should have a full recovery which may take several months to completely return to normal.

Louise Ferland, MD (retired) · Answer

Neurapraxia of the marginal mandibular branch of of the facial nerve is not uncommon after liposuction of the neck. It could resolve in a few weeks but could also take 3 months. If it is embarassing to you, I would recommend a small amount of botox to the opposite nerve to get temporary paralysis to the normal side. This evens out the smile and is a great relief to patients. Once the Botox wears off on the normal side the opposite injured side will have recovered from the neurapraxia. I have never seen permanent injury to the nerve from liposuction of the neck so rest assured the odds are it is only a temporary neurapraxia. Best wishes.

Nerve Issue After Lipo of Chin and Neck/Jaw Line

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