Numbness over one year after receiving Juvederm and Botox injection. Could the needles have caused this?

Question

I received a Juvederm injection in November, 2014. Since then I feel a numbness from my right jaw to the top of my right cheek. My smile also does not appear even. Could the needles have caused this or is it something else?

Brian S. Biesman, MD · Answer

Without more information it is difficult to answer your question.  I strongly suggest evaluation by a physician with expertise in diagnosing and managing complications of injectables.  As you are in Toronto, you don't need to go far to see someone with this expertise.

Robert Mounsey, MD · Answer

Generally injections are well tolerated by patients and long term numbness is not an issue. However, the needle can theoretically cause nerve injury. At this stage it is best to consult with the injector to how best to improve your concerns.

Wendell G. Miles, MD · Answer

It is certainly possible to have trauma to a sensory nerve in that area during injection of filler, but it is unusual for it to last this long unless some nerve fibers were actually divided. When I perform mid face filler, I do not place the filler so deeply for that reason. I would ask if your cheek is completely numb, or if you are experiencing any "pins and needles" or electrical sensations. Also have you noticed any decrease in the extent of the numb area. If the answer is yes, that is promising for the ultimate recovery of normal sensation. Injured nerves recover at a rate of one millimeter per day from the site of injury, so it can take a long time for that to resolve. A knowledgeable plastic surgeon should be able to tell you more on physical examination.

Suzanne Kilmer, MD · Answer

It’s possible the needle injured
a nerve, or the filler is compressing a nerve or the needle stick could have
hit a vessel and caused a hematoma to compress the nerve….long term numbness is
a very unusual side effect. I would go back and check with your doctor.

Steven F. Weiner, MD · Answer

There is a nerve below the eye called V2, a branch of the Trigeminal nerve that can be irritated during an injection with filler.  If you feel below the pupil, there is a small depression in the bone where the nerve exits.  Almost always, if the nerve is bruised by the needle, it recovers quickly with no side effects.  If the nerve was severely injured or severed, it can lead to a long term numbness of the cheek, upper lip, nose area.  Going down to the jaw is usually not the case.  Using cannulas makes this risk practically nil, because the nerve just bounces away from the cannula.

R. Stephen Mulholland, MD (retired) · Answer

Dear Bluebutterfly88,

These have soft tissue fillers such as Juvederm can really cause the type of post-operative numbness and symptoms you
described; however, were a sharp needle or microcannula inadvertently or to
inadvertently penetrate one of the sensory nerves to the cheek and lower part
of the face.  Anesthesia such as that is
what you describe could be possible.  The
injury can occur from the needle itself or the soft tissue filler product
injected into the nerve. In general this
doesn’t result in long-term nerve injury, but if scar tissue forms within the
nerve poor conduction can occur and long-term numbness can ensue.  In addition, a similar needle based injection
injury could have occurred to the motor nerve to the lip and face causing some
slight asymmetry on animation.Normally,
injuries such as this bruise the nerve, a process called a neuropraxia sensation
of movement return fully within six months. 
The fact that you’ve had this for so long may indicate this may be a
more long-term injury and you should seek the advice of your injector physician
and if there is no suggestion or treatment perhaps a plastic surgeon with
experience in facial reanimation or access to a Hyperbaric Oxygen and
electrical stimulation.

I hope this information has been of some assistance and best
of luck.

For more information,
please review the link below.R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

Numbness over one year after receiving Juvederm and Botox injection. Could the needles have caused this?

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