Can a torn zygomaticus minor muscle be reattached surgically? I tried to draw the issue I have on the picture. (Photo)

Question

I had a midface augumentation and soft tissue resuspension. The right side of face was alot more swollen after the procedure and I could not lift the right mouth corner when I smiled. Now 5 months after this has improved and when I smile now this side actually lifts higher than the left side. But I got some droopyness on the right side next to my mouthcorner and the cheek area is a bit flatter next to the nose. I also feel the minor muscle string with my finger on left side but not the r. side.

Peter Lee, MD, FACS · Answer

You pose an interesting question, but your picture with the penciled in diagrams only serves to obfuscate matters further.  It would be far more helpful for you to show a photograph of your face smiling and another at rest, without any doodling to obscure the picture. The first point to be made is that you cannot feel the zygomaticus minor muscle through the skin of your face with your finger.   You state that you had a midface augmentation, but you never reveal with what material it was augmented. No matter. It is far more likely that you are palpating whatever augmentation material was used in your left cheek than that you are actually feeling the zygomaticus minor muscle.Your narrative also begs the question: why are you so certain that the zygomaticus minor muscle was torn? The zygomaticus minor muscle is innervated by branches of the zygomatic and buccal branches of the facial nerve.  The far more likely explanation of what you observed is that there was injury to some of these branches during the dissection of the midface, resulting in a temporary neuropraxia.  You also have an undue faith in the ability of your surgeon to selectively injure this one very small muscle without any collateral damage. Far more likely is the probability that along with injury of the rami of the zygomatic and buccal branches  to the zygomaticus minor muscle, branches innervating  the zygomaticus major, the levator anguli oris, the levator labii superioris, the risorius, etc. were also injured.  The residual "droopyness" of your right cheek and apparent flattening of this area is also consistent with the hypothesis of a neural injury. By your estimate, you are five weeks out from your original surgery.  You would be well advised to refrain from having additional surgery of this area for several more months to allow maximal wound healing before any additional surgical trauma is inflicted here.  When you are ready, injection of fillers or fat transfer would probably be a safer way to address your residual facial asymmetry rather than signing up for a resuspension of your soft tissues or a "reattachment of your torn zygomaticus minor muscle".

James M. Ridgway, MD, FACS · Answer

The question you ask is a good one. The simple answer is
yes. However, that is working with the supposition that this is your true
medical condition. There are a number of reasons for patients to have irregularities
in their facial expressions after implant placement including, but not limited
to, swelling, bruising, and neuropraxia. I am doubtful that the zygomatic minor
was separated as this would indeed be a very unique injury. Photos with you
smiling, puckered lips and at rest with your lips slightly open would significantly
help. I would not recommend surgery
until full nerve recovery has been allowed as facial nerve reinnervation can
take up to one year for resolution. Commonly many people with neuropraxia
(injury to the nerve) regain motion within the first three months. The region
in which the procedure was performed is the most forgiving for the facial nerve.
You are still healing and should allow the proper time for this to occur. Hopefully this is helpful to you.Be healthy and be well, James M. Ridgway, MD, FACS

Brooke R. Seckel, MD, FACS (retired) · Answer

Based on your history you most likely had a Buccal Branch of the Facial Nerve injury which caused the paralysis of your right upper lip post op. This can be documented with an EMG performed by a Neurologist. I have never see or heard of Zygomaticus Minor muscle detachment.

Can a torn zygomaticus minor muscle be reattached surgically? I tried to draw the issue I have on the picture. (Photo)

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Can a torn zygomaticus minor muscle be reattached surgically? I tried to draw the issue I have on the picture. (Photo)

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