Delayed healing or neuropathy two years after a SMAS plication, neck lift, and an extensive upper and lower blepharoplasty?

Question

In April 2024, I underwent a SMAS plication, a neck lift, and an extensive upper and lower blepharoplasty. Now, almost two years later, I still experience a pressing sensation behind my ears and a tight, stretched feeling in my cheeks near my ears. The sensation in my cheeks is reduced; for example, I do not feel cold there as I do in other parts of my face. When I smile or use facial expressions, my cheeks still feel tense and tight. Could these symptoms indicate delayed healing (for example, due to scar collagen remodeling), or should I be thinking about neuropathy because of the tight band-like sensation and the altered sensitivity in my cheeks? If this is neuropathic pain, is it likely to resolve over time?

Semih Yildiz, MD, FEPOBRAS · Answer

Symptoms two years after a SMAS plication, neck lift, and blepharoplasty should be evaluated in person rather than assumed to be normal healing. Some numbness or altered sensation can occur after facial surgery, but persistent pain, tightness, or neuropathy-type symptoms deserve a focused exam.
I would start with your original surgeon if possible, because they know exactly what was done. If the symptoms feel nerve-related or are worsening, a neurologist or pain specialist may also be helpful. Revision surgery is not usually the first step unless there is a clear structural problem to correct.

Phuc Dinh, MD · Answer

At two years post-op from a SMAS plication and neck lift, the active healing and standard collagen remodeling phases are generally complete. The symptoms you are describing: altered temperature sensation, a pressing feeling behind the ears, and a tight, band-like sensation during facial animation, it points more toward neuropathy or sensory nerve entrapment rather than standard delayed healing.During deep plane work or SMAS plication, sensory nerves (such as the great auricular nerve behind the ear) and smaller cutaneous branches are inevitably manipulated. In some cases, dense scar tissue can tether these nerves, or the underlying plication sutures can create lasting tension that causes these exact sensations.Will it resolve over time? While minor nerve regeneration can happen very slowly over several years, symptoms that are still this pronounced at the two-year mark usually require proactive management rather than just "waiting it out."I highly recommend consulting in person with a board-certified plastic surgeon or a neurologist. They can perform a physical examination to pinpoint the exact nerve involvement and discuss management options, which may include targeted steroid injections, nerve blocks, specialized massage therapies, or nerve-calming medications to help give you some relief.Wishing you the absolute best moving forward.
Dr.Phuc Dinh

Delayed healing or neuropathy two years after a SMAS plication, neck lift, and an extensive upper and lower blepharoplasty?

Answers (2)

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