How long for Infraorbital nerve damage to heal following 0.5ml of HA filler in cheek 10 months ago?

Question

I had 0.5ml HA filler per cheek 10 months ago. 5 days after procedure I experienced nerve pain near the infraorbital foramen on my right cheek. The pain has waxed and waned over 10 months. The pain has decreased over this time but could this be permanent? I would love to hear Dr's advice about how long this could take to heal and if it will heal. I am pretty concerned and so sick of the discomfort. Has anyone seen any patients with the same concern and what was the outcome?

Nirmal Nathan, MD · Answer

Dear Silverlining10,Thank you for your question. It is extremely uncommon, but possible, to have infraorbital nerve pain after filler injection to the cheeks. This injury is usually sustained by direct injury to the nerve or hematoma formation (which may not be seen at the surface). This complication can be avoided with basic anatomical knowledge of where the nerve comes out of the bone. It can take 12-18 months to fully recover, although I usually give this timeline for surgical questions, not injectable. You could try reversing the filler to see if that helps. If it continues to get better that is a good sign. If it is persistent, you may want to see a neurologist and try neuropathic pain medications if it is disabling.Good luck,Nirmal R. Nathan, M.D.
  
Certified, American Board of Plastic Surgery
  Member, American Society of Plastic Surgeons
  Fellowship-trained Craniofacial Surgeon

Misbah Khan MD, FAAD, FACMS · Answer

not sure if this is still an ongoing issue for you but why not get the filler dissolved completely? unless that was already tried? even if it was tried maybe there is still some filler left in there that's causing the pressure on the nerve. u never know. there are measures to resolve this pain. no reason for you to be in so much discomfort.

Chadi Dahabra, MD · Answer

Thank you for your question. Sometimes less is more. Neuropathic pain after injury from pressure will resolve spontaneously in most cases over time. I won't try any intervention till after 1.5 to 2 years. If meanwhile you have severe pain then you might try non-opioid pain medication or Gabepentin. Consult with your Dr. regarding that. The best course is to refrain from taking  any pain med as they all have their side effect and to to wait it out. Hope it'll resolve soon.

Jesse E. Smith, MD, FACS · Answer

I perform many facial fracture repairs per year for various forms of trauma.  My patients that experience transient infraorbital nerve damage during their injury usually recover within 12-18 months.  Occasionally, some have longer revery; however, most get full recovery.  Nerves just take time to heal.

Reginald Rice, MD, FACS · Answer

Sorry to hear about this injury. The good news is that it most assuredly will go away if the injury was only filler related. Bleeding at the nerve or direct trauma from the needle or compression from placing HA into the opening the nerve comes out of are the likely causes.  Some studies show that nerves grow about a millimeter a month, so patience is in order as it could take another year to settle down to normal function.

Thomas Copperman, MD · Answer

Infraorbital nerve damage from an injection would be highly unusual. It is possible there is irritation of the nerve from the filler rather than direct injury from needle. And if it occurred 5 days following the procedure it was unlikely from the needle or canula injection itself. This is also around the time when the filler pulls in water and starts to swell. You could consider dissolving to see if it was a compressive effect from the filler.

Derek Norcom, MD · Answer

I recommend seeing a neurologist to rule out other causes of facial pain and if nothing is found maybe consider having the filler dissolved. If it is somehow the HA causing the nerve pain that might help, but if the nerve pain is from needle or cannula injury to the nerve then it wouldn’t likely help.
Also you might try acupuncture in the meantime - it sometimes helps greatly with nerve pain.

Sergio Verduzco Casillas, MD · Answer

I really havent heard about a case like  yours i recommend a second opinion and also improvement should come when the HA dissolves after 1 year

Jerry Tan, MD, FRCPC · Answer

Sorry to hear about your persistent discomfort.
Pain 5 days post-injection suggests compression neuropathy. Ultrasound examination would be useful to determine the site of compression and etiology (HA filler versus hematoma). If HA filler is visualized, directed hyaluronidase infiltration to the offending site can decompress the filler by dissolution.
Hope this helps.

Rey N. Bello, MD · Answer

Intraorbital nerve injury after HA filler is uncommon, but theoritically could happen. In my opinion, there are 2 scenarious which the nerve can be injured, first by direct needle injury to the nerve without transection (or total disconnection of the nerve) can happen which may result in pain until the nerve recovers which usually takes around 12 weeks depending of the degree or damage, sometimes even minor injury to the nerve can develop abnormal nerve re-growth (neuroma formation) which can cause longer lasting pain. The second possibility is compression neuropathy which may happen due to pressure to the nerve which can happen due to a foreign substance introduced in the nerve area or hematoma which usually resolves more quicky. Compression neuropathy usually lasts until the compressive pressure is released. Again, since I have not seen you personally, these are just my theoretical opinions and not considered your diagnosis. I advise that you see a physician with expertise in managing neuropathic pain to properly evaluate you and do the necessary work up and do the necessary treatment for you situation.

How long for Infraorbital nerve damage to heal following 0.5ml of HA filler in cheek 10 months ago?

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