Risk of Nerve Damage with Chin/neck Liposcution?

Question

I am looking to book my liposuction procedure for my chin/jowl area, but am absolutely terrified of having nerve damage causing a droopy mouth... im really just worried about ruining my face because i want to change the shape of my neck/chin, from the front im happy,looks defined, i just hate my side profile, the face goes straight down, no angle is this ever permanent? if it were to happen (fingers crossed) will it ruin my face forever? what are the chances this will happen at all? Thank you

S. Larry Schlesinger, MD, FACS · Answer

I have literally done over 1,000 liposuctions of the neck and have never seen any permanent nerve damage.  Back in the early 1980's when we used large cannulas, blunt trauma to the muscles of the neck caused temporary injury to one's smile, but I have never seen a permanent injury.  In traditional liposuction, we now use very small cannulas in the neck, 3 mms internal diameter or even less.  I do all my liposuction of the neck through a small incision just underneath the chin and have not even seen any temporary injury for over 20 years.  The nerves to the muscles of the neck and face come in under the muscles, therefore injuring the nerves directly is incredibly difficult but not impossible.  

	The obvious answer to your concerns is choose a Board Certified Plastic Surgeon, certified by the American Board of Plastic Surgery.  See at least three of these plastic surgeons, look at before and after pictures, and speak to at least one patient of each of these surgeons.  This process should give you a sense of comfort, and I am sure you will pick the right surgeon for you.

	Post operatively, I use ultrasound (the kind the physical therapists use on sore muscles).  We do about 8 treatments, 5 minutes each, and this definitely speeds the recovery.

Martin Jugenburg, MD · Answer

Yes, there is a risk of injury but the risk is small in the hands of a skilled plastic surgeon.  Most common type of injury is a 'bruise' to the nerves.  The liposuction instrument used is extremely unlike to cut a nerve.  It is more likely to bruise it which leads to 'neuropraxia', a temporary injury.  This neuropraxia can last from minutes to months.  The nerve that provides stimulation of the lower mouth/corner is most likely to be injured.  This can lead to a droopy corner of the mouth.  If this happens, the initial treatment would be to simply observe as most likely this will resolve on it's own.  In extremely rare cases additional surgery is required to repair this.

	While the risk of this is small, it is never 0%.  The best way you can prevent this from happening is making an informed decision on who will perform this procedure.  Your plastic surgeon should be able to show you several pictures of his own before/after patients.  You want to see that 1) he/she has performed many of these procedures and 2) the results are what you would like to see.

	 

	Sincerely,

	Martin Jugenburg, MD, FRCSC

	Toronto Cosmetic Surgery Institute

Michael Law, MD · Answer

Liposuction, as you may have heard in the popular media, is the most commonly performed surgical procedure each year in the United States. Here's a statistic that you may not have heard: the majority of physicians performing liposuction in the United States are not plastic surgeons; in fact, many do not have any formal surgical training whatsoever. It seems hard to believe, but many physicians performing liposuction have had no more training in liposuction than a 'weekend course'. One way to determine whether or not a physician has had appropriate training in a particular surgery is to confirm that they have hospital privileges for that procedure.
	I fear that some practitioners view liposuction as a 'simple' surgery, since it does not involve making large incisions, and it requires little, if any, suturing. Nothing could be further from the truth. Liposuction, in my mind, is a very challenging operation that requires careful planning and preparation, and a great deal of care and finesse when it is actually performed. It requires a three-dimensional understanding of the layers of human anatomy, an understanding that is second nature to a surgeon alone. I think that it is often an inadequate understanding of anatomy (and, perhaps, of the body's response to surgery) which leads to the poor results in liposuction and body contouring that unfortunately are so often seen.
	When performed expertly, on an ideal candidate, neck liposuction can transform the face, making a person look years younger and often much lighter. Some individuals have 'sagging' necks primarily due to fat accumulation below the jawbone (mandible). In some cases, liposuction alone can significantly improve the neck appearance. Liposuction is also frequently combined with surgical neck rejuvenation, and in selected cases some direct excision of fat (through a hidden incision below the chin) is performed. The reduction of fat in the area below the jawline and in the anterior neck almost always makes the neck appear longer, and makes the patient's profile appear more elegant or refined.

Steven Wallach, MD · Answer

Sometimes patients develop a bit of a neuropraxia ( weakness) of the motor nerve that activates the muscles around the lower lip but if this does happen ( which is rare) it often comes back within 6-8 weeks because it is often jsut bruised.

Barry L. Eppley, MD, DMD · Answer

The potential nerve damage to which you refer from chin/neck liposuction is that of the marginal mandibular branch of the facial nerve. This supplies some movement to the lower lip. It crosses over the lower border of the jaw at the side the chin. It can potentially be traumatized if liposuction is done too far up around the jowl area where the nerve is very close by. It can be avoided by not trying to be too aggressive with treating the jowl area and staying below the border of the jaw, confining the movement of the liposuction cannula to the neck area only. Even if the nerve is traumatized, the blunt cannulas will not cut the nerve but bruise it. This may cause some temporary weakness but almost never permanent paralysis.

Keith Denkler, MD · Answer

Liposuction cannulas are blunt so therefore they don't sever tissues.  The small nerves can be temporarily suctioned into the holes and cause some bruising, but the nerves recover over some months.  The most vulnerable nerve is the mandibular nerve which is actually deeper than the superficial fat.  Sensory nerves will be irritated by the cannula motion and it will take some time for all the sensation to return.

	You should respect your emotions and consider holding off on the procedure since the risk is not 0%.  Even with excellent technique there can be temporary paralysis.

Lawrence Foster, MD (retired) · Answer

Chances are 1 in a 1,000 and if it does happen it's only a bruised nerve and full recovery will happen in several months. But Laser lipo can cause a permanent problem. Stick with standard tumescant lipo.

Ricardo Izquierdo, MD (retired) · Answer

Though liposuction uses blunt cannulas, there is a small, but appreciable chance that a nerve, most commonly the marginal mandibular nerve to the corners of the lip, can be traumatized. When this occurs, the affected side will not be able to "frown" and smiling will occur only on the opposite side. This injury is usually temporary and will resolve in several weeks time.

Risk of Nerve Damage with Chin/neck Liposcution?

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