How Do Doctors Prevent Damage To Nerves Under Skin In Facial Procedures?

Could you please explain how the nerves in the face are safe from being damaged from a facelift, Injections, Thermage, Fraxel, Botox etc? When is it too much? Of Course not all at once, but over time. It amazes me how they aren't damaged. How do plastic surgeon know when and how to stay away from a nerve? Thanks

Doctor Answers 10


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I hope the avoidance of complications has something to do with the 7 years of training AFTER college and medical school. That is why we emphasize patients need to see a board certified plastic surgeon for these surgical treatments - complication avoidance. There are two types of nerves under the facial skin, sensory nerves that allow touch to be felt and motor nerves that tell the muscles when to move. Sensory nerve twigs are always damaged during facelifts and always return, thus the temporary numbness. Motor nerves are much deeper in the layers of the face and also larger and we know where they are through an estensive study of anatomys so we can avoid them. Nevertheless they are still occasionally injured (but not cut) and if they are injured will regenerate in 2-4 months. The nerves are not an issue for thermage and injections.

Portland Plastic Surgeon
5.0 out of 5 stars 29 reviews

It comes with experience

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First of all, many of the procedures that you describe such as thermage and Fraxel are very superficial procedures that don't penetrate to the level of the nerves. Secondly, Botox is intended to affect the nerve by interfering with the nerve transmission to the muscle. Thirdly, plastic surgeons experienced with facelifts know where the nerves are that move the muscles of your face and are careful in their dissection of the different tissue planes in order to avoid damage to those nerves. During the dissection there are very superficial nerves that supply sensation to areas of your skin and they may be cut as a matter of course during the facelift but those nerves regenerate.

I can't stress enough the importance consulting with a board-certified plastic surgeon and asking him these questions. Ask him to show you before and after pictures of his patients.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Knowledge and experience contribute greatly to safetly and an excellent result in facelift surgery.

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With knowledge and experience, a facile surgeon can reliably and successfully avoid the critical branches of the facial nerve.

When a nerve is damaged, it is usually from sharp instrumentation, the nonsurgical techniques you mentioned do not typically cause damage to the branches of the facial nerve.

Best wishes.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

Facial nerve injury

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The best prevention is to go to soemone who is board certified and also has done a number of facelifts.There is no sunstitute for experince.You can't get it from reading a textbook.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 69 reviews

Preventing Nerve Damage in Facial Procedures

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The most important thing a patient can do is to choose the right Surgeon.  Facial nerve anatomy is very consistent in location, and is more of a theoretic risk for an experienced Facelift Surgeon.  For facial surgery, I would recommend that you see a Board Certified, Fellowship trained Facial Plastic and Reconstructive Surgeon or a Board certified Plastic Surgeon.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Avoiding nerve damage in the face

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Plastic surgeons have extensive training and experience with the nerves and blood vessels of the face. That said, a majority of nerves connect to the muscle from under the muscle. There are three nerves/muscles of the face that are classic exceptions to this this rule. Injuring these nerves with fillers would be very unusual and would mean the injection was placed too deep. As for Botox, the toxins can migrate to the nerve and create a temporary nerve paralysis. Finally for facelifts, plastic surgeons are very keenly aware of the nerve locations and very carefully avoid them by knowing when to stop dissecting being careful whenbthey are close to nerves. That said, permanent nerve damage in experienced hands is very very rare.

Preventing nerve damage during a faclift

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Facial nerve injury is a risk during a facelift, though careful technique, and knowing the anatomy is important to reduce the risk of any injury. Non surgical facial rejuvenation such as Botox or laser would not cause you any risk for nerve injury.
Best of luck,
Peter Johnson, MD

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

How Do Doctors Prevent Damage To Nerves Under Skin In Facial Procedures?

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That's why it takes years of training and experience to become a plastic and cosmetic surgeon.  The motor nerves are deeper and not prone to damage from fillers and superficial skin treatments as they are with surgical procedures like Face Lifts.  

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Strong Understanding of Anatomy To Avoid Nerve Damage

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The best way to avoid complications is to know what causes them.  In a facelift, for example, you need to find the most qualified board certified specialist who has a strong understanding of the underlying anatomy to avoid damaging the facial nerve.  The same principle applies to most other procedures.  Do your research!

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Its all anatomy!

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The understanding of facial anatomy is essential to the training of a plastic surgeon.

This is what allows plastic surgeons to do the many things we do in and about the face.

Each technique is designed to protect not only the nerves, but muscles, shapes, etc.

Nerve injury is one of the most rare complications of facial plastic surgery.

Dr. Mayl

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

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.