Lack of Mouth Movement, Unable to Blink or Pucker: All Results of Facelift?

Question

26 days after mid face lift, I have a knot 1 inch in front of rt ear size of small marble.Upper mouth won't move, can't suck or pucker or say words with B or P good.Right eye still not blinking.Is this all same problem?

Sam Naficy, MD, FACS · Answer

Midface lifts (compared to face and neck lifts) do have an increased risk of this complication.  The odds are in your favor that over time the function will improve

Vivek Bansal, MD · Answer

It sounds like you may have several problems at once.  You may just have some swelling and or you have some bruised nerves.  See a Board Certified Plastic Surgeon for a consultation and evaluation.

Steven H. Williams, MD · Answer

Thanks for your question -

	It sounds like you are describing is a facial nerve weakness or injury.  You should follow up with the plastic and cosmetic surgeon that did your Face Lift so the degree of this weakness can be ascertained. 

	Many times small amounts of weakness improves over 3-6 months.  In your case it sounds like there may be multiple nerves of concern.  In addition, inability to blink can create dry eye which can lead to corneal ulceration.

	These issues should be evaluated by your surgeon.  Don't hesitate to get a second opinion.
	
	I hope this helps.

Houtan Chaboki, MD · Answer

Hi Linda,

	Your description suggests weakness of the facial muscles and nerve, which could potentially occur after face lift surgery. Typically, this facial weakness is temporary and resolves with time.  You should speak with your face lift surgeon. Only after a comprehensive evaluation can he/she help determine appropriate options for you. Best of luck.

Benjamin C. Marcus, MD · Answer

What you are describing is a problem with your facial nerve. 26 days post-surgery this is very unlikley due to swelling - especially because of your eye symptoms. So you need follow up with your surgeon to determine if this is a temporary or permanent injury to the nerve. You also need to make sure that your eye is protected. Prolonged exposure during sleep can lead to a corneal injury.

Kenneth D. Steinsapir, MD · Answer

Linda

	You are describing could involve just the buccal branches of the facial nerve. The buccal branches will supply the muscles that affect the muscles that make the smile.  The blinking issue could also be the effect of the buccal branch of the facial nerve.  An actual examination is needed to know precisely your issues.  It is likely that the surgery injured one major branches of the buccal nerve.  These can recover or the  injury may be permanent.  One concern with the blink is corneal drying.  An oculoplastic surgeon can assess you for eye drying.  However, I would not be in a hurry to have more surgery.  There may be some recovery of function and this can take several months.  A second opinion is reasonable and appropriate.

Alan B. Brackup, MD, FACS · Answer

The description you provided suggests that there has been a compromise of two of the branches of the facial nerve, the zygomatic and the buccal.  This may have occured as a result of swelling, tension on the nerves, bruising or heat injury to the nerves, or less likely, severing of the nerves during surgery. 

	The good news is that paralysis of these nerves is rare.  There are numerous interconnections between the nerves and restoration of function is typically restored.  This can however take weeks to upwards of a year.  Again, the good news is that the odds strongly favor recovery.

Gregory J. Vipond, MD, FRCSC · Answer

Facial muscle weakness after surgery is not very common, but it can happen. The most important factor in determining if this will improve on its own or will need further treatment is to distinguish between weakness and complete paralysis or no movement at all. Weakness is usually due to swelling around the facial nerve branches and will strengthen with time and should completely recover, although it can take up to 6 months to a year. If there is complete paralysis, the recovery is less certain. Often there will be some return of movement to the cheek and upper lip, but the forehead, eye, and lower lip are less predictable. Hopefully you have seen your surgeon after your procedure and he/she is following your progress. It is essential to keep your eye moist with artificial tears and lubricating eye ointment so that there is no loss of vision.

Michael McCracken, MD · Answer

You need to be evaluated by your surgeon for the cause of your nerve weakness, and probably seek a second opinion as well. Also, if your eye is not closing you need to see an oculoplastic surgeon or ophthlamologist to make sure that your eye is being protected and not at risk for developing an infection.

Brooke R. Seckel, MD, FACS (retired) · Answer

The weakness of your lips and mouth 26 days after Mid Facelift suggests injury to the Buccal Branches of your Facial Nerve. Eyelid weakness suggests injury to the Zygomatic Branch of your Facial Nerve on that side.

	This can occur when dissection is done too deep during Mid Facelift surgery.

	Fortunately these branches of the Facial Nerve have many intercommunications so recovery is possible.

	You need a professional evaluation by a Neurologist and EMG testing to determine the exact extent of Nerve injury.

	Direct Current Electrical Stimulation of the weak muscles with a handheld stimulator made by Med Labs in Goletta, California can help preserve muscle tone while nerves are regenerating-you will need directions from your doctor on how to use this device.

Lack of Mouth Movement, Unable to Blink or Pucker: All Results of Facelift?

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