Persistent Pain a Year and Half After Face Lift

Dear AnnChloe,

It sounds like the great auricular nerve was injured during the facelift.  This injury can be common after a facelift.  Usually, altered sensation in this area ranging from decreased sensation to hypersensitivity can be experienced for up to 3-6 months after the surgery.  In cases of hypersensitivity, it is best to stimulate the area with touch and different materials.  You can start with a feather and work your way up to more firm objects/textures.  

In your case, it sounds like there was more than a simple neuropraxic injury (nerve bruise).  I worry that you may have a neuroma (scar tissue in nerve) at the site where the nerve was injured.  If this is the case, you would need the incision to be opened in the area of the great auricular nerve, and have the nerve buried in fat or muscle so that your sensitivity resolves.  It may also be possible to cut out the scarred section and repair the nerve.  It would depend on how the nerve appeared under an operating microscope to decide how to treat the neuroma.  

I suggest seeing your surgeon again and mentioning this possibility.  If you feel like your surgeon isn't listening to you, I suggest you seek a second opinion.

I hope this helps.

Sincerely,

Asif Pirani, MD, FRCS(C)

It’s not unusual for patients to have pain and numbness
following facelift surgery. These
symptoms usually resolve in 3 to 6 months following this procedure. It’s unusual for pain and numbness to
persist for 18 months, unless the nerves have suffered structural damage. When this situation arises the source of pain
should be rigorously investigated. The
sensation that you describe is known as a dysesthesia. The location of your pain suggest possible
injury to the greater auricular nerve. Injury to this nerve could explain the distribution of your tingling
sensation.In most
cases dysesthesias resolve with the passage of time. After 18 months, atypical causes of this type
of discomfort should be considered. In
some cases, injuries to the greater auricular nerve can result in the formation
of neuromas. When
neuromas are encountered surgical intervention may be required. Under these circumstances partial elevation
of the facelift flaps may be necessary with exploration of the wound to address
the neuroma.When
neuromas are encountered consultation with a board certified plastic surgeon is
appropriate. This surgeon should be able to formulate an appropriate treatment
plan.

You describe a neuroma in the greater auric ulnar nerve .  This is a sensory nerve that supplies sensation to the ear. Injury to this nerve can also cause sweating in the cheek area when chewing.

The treatment at this point is to explore the nerve find the neroma excise and repair.  Not a 100% cure rate but the next step in my option after a year and a half.

Pain 18 months after the procedure is certainly not normal.  It is not unusual to have this in the first few months after surgery but it typically goes away within the first 6-12 months.  I agree with trying massage as an initial step.  Although it seems counter intuitive, it may help decrease your sensitivity.  Evaluation by a neurologist might be helpful if the massage does not adequately relieve your symptoms.

Sorry to hear that you're experiencing discomfort with your face lift procedure. This is an unusual event. Out of nearly two thousand face lift procedure I have performed, I had one patient in the past that experienced similar prolonged discomfort. After treatment with Neurontin, Kenalog injection to the triggered point, as well as massaging her discomfort resolved. Wish you well.

Depending on the nature and location of the pain, it may be worth re-elevating the skin (flap).  This has been reported to allow the nervers to re-innervate the skin.

While this isnt definitive, it is a simple enough thing to try to relieve your symptoms as this isnt typical.

This is an unusual complication after a facelift. Your physician is correct that it may take considerable time for the nerves to heal after a surgical procedure. Every patient will heal differently and it is hard to know exactly your situation without an examination. It some circumstances, an evaluation by a neurologist or a pain specialist could be beneficial.  

Persistent pain after a facelift is highly unusual.  Some diagnoses to be considered:


Hypertrophic Scar or Keloid- Can give the sensation of pain after the procedure, particularly at night.  Treated with Kenalog injections which can treat this quite effectively.

Neuroma- Highly unusual to see after a facelift.  In cases where surgeons have to cut the greater auricular nerve (i.e Parotidectomy), neuromas are rare.  In fact, studies did not see a difference in pain in which surgeons cut the greater auricular nerve in those which did not.  The greater auricular nerve should not be seen in facelift surgery.

Nerve Impingment-  Possible to see a suspension suture impinge on the nerve.

Permanent sutures- Can react  differently in some patients.

Prolonged regrowth of nerves-  Regrowth of nerves occurs at a different rate in different patients.  Although the book answer is that all sensation is back in one year (most commonly it is a few months), it can take up to 2 years.


 

From the position of your pain and its distribution, it sounds like there might be damage to the Greater Auricular nerve.  This is an easily fixable problem.  The neuroma on the end of the nerve can be buried deep in the muscle upon which it sits.  Anesthesia of a portion of the ear will be a side effect.

A generalized, albeit temporary loss of sensation in the area of the skin flaps is not unusual after Facelift surgery. It typically resolves within 3-6 months and sensory nerve re-growth ( 1mm per day) is heralded by tingling sensations known as parasthesias. Permanent and/or uncomfortable sensations are referred as dysethesias and usually relate to some abnormality in nerve regrowth such as a neuroma. I have seen a number of patients who have had quickie lifts elsewhere experience this problem. I have had good results ( 3 month duration) of pain relief using Botox.