I have a facial nerve injury post face lift. Is it reversible?

Question

Days after my facelift w/fat transfer under eye/cheeks I noticed I had facial weakness/paralisis on one side . I could not lift my eyebrow, I had teary eye and the eye blinking was affected too. Now, 5 months later I have partially recovered but i worry that I still have numbness and my eye will not fully blink (or close evenly) - shape of eye changed (outside corner of eye looks down), droppy eye?, is this due to weakened muscle, is the nerve damage reversible?

Eugene Kim, MD · Answer

You
definitely need to see your doctor for this.If there is a nerve injury it’s
better to recognize and address it early.If you wait too long it may be
irreversible. Weakness and numbness can happen early on with a facelift, but
usually subsides within a few weeks. Surgeons have the ability to do a nerve
study, which can identify any issues. If the nerve is injured due to
stretching, then it may be reversible, but if it was cut, it may not be
reversible without surgical repair.

Jed H. Horowitz, MD, FACS · Answer

I am sorry to hear that you have experience this unfortunate complication. You should definitely see your surgeon for an examination and discuss treatment options based on examination.

James M. Ridgway, MD, FACS · Answer

Dear
wxwv2000,I am
very sorry to hear about the challenges that you are going through. Facial
nerve injury is a very rare event in facelift surgery and the consequences are
both physically and emotionally tough for all affected people. The prognosis of
your recovery is directly related to the particular nature and extent of the
injury, the resulting functional compromise, and viability of the remaining
facial nerve segments. These factors, when taken together, allow one to forecast
your recovery and review any therapeutic options that may, or may not, be
necessary. It is helpful to know that the injury was within the last year. It is
also important that your eye closure on the affected side is intact and to have
any exposure addressed so as to prevent any symptoms related to eye exposure
which can lead to eye injury. A general principle in treatment of facial
paralysis is the allowance for the surviving facial nerve to have the
opportunity to reinnervate the facial musculature. EMG (electromyography) is a
gold standard method in assessing facial muscle nerve innervation and is
standardly performed in all patients who have a facial nerve paralysis of 12
months or greater. Light facial massage in the regions of injury help to
stimulate nerve reinnervation to the given region. Hopefully this is helpful to
you and I hope you are doing well.My best,James
Ridgway, MD, FACS

Ronald J. Edelson, MD · Answer

Facial nerve weakness is a rare but the ne'er standby distressing complication from a facelift.  The good news is that 80 percent of facial nerve problems after facelift will resolve on their own, but could take up to one year.

John Michael Thomassen, MD · Answer

Nerve damage is reversible if the nerve is only stretched and not cut.  In this case, the injury is called neuropraxia and nerve function usually returns by 3 months time.  If the nerve is cut, the injury is called axonotmesis and recovery of function may not return.  The loss of brow function suggests injury to your temporal branch.  If it has returned, the injury was only a neuropraxia.  If your brow function has returned, yet you are unable to close your eye fully, an orbital branch of the temporal nerve was injured or the zygomatic branch of the facial nerve was injured.  There are multiple nerve branches to the orbicularis muscle that makes the eye close and many times these multiple branches compensate for the loss of a few injured branches.  At 5 months, it may be a consideration to undergo a canthopexy to correct the lateral lower lid lag you are experiencing.

John J. Martin, Jr., MD · Answer

Nerve injury can occur during the surgery. Usually in about 6 months the function has returned, but it can take longer.  The numbness is actually a different set of nerves.  That will also improve. The main issue is the eye not closing well.  The nerve to the forehead also innervates the muscles that help you blink.  Until the blink is normal, you will need to keep the eye lubricated with artificial tear drops, and ointment at bedtime.  You should see an ophthalmologist if you are having issues with dryness.

James Bonaparte, MD, MSc, FRCSC · Answer

I am very sorry to hear of your issue. Facial Nerve (the nerve that controls the muscles of your face, including some eye muscles). One thing to remember, the facial nerve can take up to 12 months to fully regenerate to the forehead and upper eye lid. The key is, you need to ensure someone (a physician) is watching your eye. You need to ensure it is not dry and tearing too often. I would highly recommend asking your physician about this. I hope things start to improve, another option would be to ask to see an ophthamologist, they can do a temporary procedure to help your eye close normally while you wait for healing. Dr James P. Bonaparte, MD, MSc, FRCSCJB Cosmetics and Facial Surgery of OttawaOtolaryngology – Head and Neck SurgeryPracticing in Facial Plastic and Reconstructive Surgery

Gary L. Ross, MBChB, FRCS · Answer

Sorry to hear of your troubles. The numbness can take 12-18months to return and this is a separate issue to the facial nerve issue you describe. If you are having some recovery of the facial nerve then I would be hopeful that the nerve has only sustained a neuropraxia  / stretching. I would keep in contact with your PS as the most important aspect is that your eye is protected especially at night. It is possible to help and improve the appearance but it is often best to wait until you are not seeing any further recovery before considering the surgical options. If you have concerns about your treatment I would always recommend a second opinion through a face to face consultation. Patients often find this reassuring even if the same treatment regime is recommended.

Gustavo A. Diaz, MD · Answer

Hi wxwz2000,I am sorry to hear about your experience.The first thing that you need to remember is if you came out of the surgery with that problem or if it happened several days after. The reason this is important is because if you came out of surgery with this problem you have to think that one of 2 things happened. Direct injury to the facial nerve, or stretch injury to the facial nerve.Direct injury to the facial nerve is caused by cutting the nerve. This gives immediate loss of function and the patient wakes up without the ability to move the facial area. This is a problem that might be permanent as the nerve was cut and not necessarily the ends could connect again.Stretch is swelling injury to the nerve can happen at the time of surgery or several days later. With this type of nerve damage the nerve has not been cut but instead it goes "dormant" for a while because it was stretched and this is a response that many motor nerves can do. This is the best scenario of damage because the nerve regenerated and function comes back in the great majority of the patients (90% plus). This damage can be seen immediately after surgery or it can take several days to develop. All surgeons will see this type of facial nerve injury in their carrier. Swelling is swelling and it will do what it can do.The last type of problem to the facial nerve can happen several hours to days after the surgery and is the classical bells palsy. The nerve stops conducting, the muscle stops moving, but the recovery is almost 99% in the majority of the patients.The way that you are describing the injury, you noticed it several days after the surgery. You are also describing that you are recovering from it as you are now able to move the area that was affected. Hopefully the injury was due to stretch or due to a Bells Palsy. It is imperative that you go back in time and remember if you did not woke up with this problem, because the scenario changes and you will have to consider direct injury to the facial nerve.Many patients have to wait a year to see how much they recover.As a surgeon, if you do the amount of facelifts that I do (around 400 a year since 2009) you will experience the things that the facial nerve will do. I have seen some stretched nerves and Bell's Palsy in my carrier, but thanks to God not a permanent facial nerve damage. It is part of the risk of doing facelift and something that I discuss with all my patients. Be worry of the surgeon that claims that has never had a problem with the facial nerve because they are either lying or they have not done enough surgery. We will all have some problems, the important thing is not to do permanent damage.Hope this helps,Dr. Gus Diaz

Todd C. Miller, MD · Answer

Hi wxwz2000, facial nerve weakness is a possible risk during a facelift procedure. This typically occurs as a result of swelling around branches of the facial nerve. Rarely, it can result from actually severing the nerve. If you have recovered some function of the nerve, it is likely that you will recover most, if not all, function of the nerve. It is very important to take meticulous care of your eye. Artificial tears, lubricant for the eye while sleeping, and an opthomology evaluation would be beneficial. The numbness that you are experiencing is a different issue. This is caused by inflammation to sensory nerves. This is very common and gradually resolved over several months after a facelift. I would follow up with your surgeon to ensure that you are recovering according to plan.

I have a facial nerve injury post face lift. Is it reversible?

Answers (14)

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