21 days post op, my ride side has issue. My eyelid and lips has limited movements. Is this normal?

21 days post-op mid-facelift w/fat Xfer. Limited eyelid movement (ie, right eye: can’t blink & lid won’t fully close (injury to Buccal Branches?). YES, I'm properly managing my eye & also use Rx Erythromycin. Little to no movement of right upper lip (injury to Zygomatic Branch?). A common injury?? 2 separate injuries?? I am in touch w/my PS. Will also see a PS specializing in facial paralysis. Will I find definitive answers to the extent of the injuries & a prognosis for complete recovery??

Doctor Answers 7

Swelling can cause motor disturbances for a few weeks after a facelift.

The inability to blink normally or muffling Of other facial expressions may be due to swelling after a facelift. Damage to motor branches the facial nerve should not occur as a consequence of the facelift.

Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Possible nerve injury from face lift.

Thank you for your face lift question.
  • Sorry your ride let you down -
  • And sorry you are having these problems.
  • (Just an anatomical note - the buccal branches go to the cheek and lip, and zygomatic the eye).
  • Although unusual, both branches can be injured in a mid-face lift - but the main branch is more likely. 
  • It is most likely that bruising of the nerve is the problem. If so, it may take months to recover but there should be slow signs of improvement. 
  • Nerve conduction studies can be done to assess the nerve to give you specific information about its function but swelling may make the studies harder to assess this early after surgery.
  • An unlikely possibility, but strange things happen, is that you have Bell's Palsy complicating your surgery.
  • See your plastic surgeon when you can. Have your nerves fully assessed. 
  • See the one specializing in facial paralysis - and give this time. Best wishes.

Facial nerve

Sorry to hear about your nerve issues. After a facelift there is a possibility of temporary weakness to one or some of the branches of the facial nerve.  Usually due to bruising of the nerve directly or swelling around it from surgery.  It sounds like your have some movement which indicates that the nerve is intact.  These injuries do recover but can takes a few months for full recovery. I would continue with your eye treatments and regular follow up and you should start to see progress soon.

Khashayar Mohebali, MD, FACS
Bay Area Plastic Surgeon
4.9 out of 5 stars 10 reviews

Possible facial nerve injury most likley temporary

It is possible that you have a temporary weakness to these branches of the facial nerve.  More than likely these are due to a bruising of the nerve.  If you have some movement and not absolute paralysis of the nerve then the function will definitely come back over the next 4 to 8 weeks.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 16 reviews

Facial Nerve Injuries Usually Temporary

Thank you for your question.  I am sorry to hear about your complication.  Fortunately most facial nerve injuries after facelifting are temporary in nature and have a very good prognosis.  Most of the nerves are stretched during the dissection and not cut.  This means that as the lining of the nerve recovers, the function returns. In the mean time physical therapy can be beneficial and watchful waiting.  Best wishes on your recovery.

Nerve Injury after Mid Face lift

I am sorry to hear about your complications. Most of these injuries are called a neuropraxia from overstretching the nerve. These injuries will gradually recover over time, but it can take several months. Partial or complete cutting of the branches in the mid face take longer to recover, but there is more cross innervation of these branches, so again, some to all of the function usually returns with time. Continue to follow up with your surgeon, but patience versus repeat surgery is the best option for recovery in most instances.

Movement issues

Difficult to make any assessment via this forum. The majority of the time, any injuries of the "midface branches" of the facial nerve are temporary. Unusual to completely disrupt them and lots of "crosswiring" of the branches all allow good recovery most often. This can certainly take many months if more severe. Taking proper care in the meantime, as you are, and having baseline evaluations, as you are, is a great approach.

Robert H. Hunsaker, MD
Miami Plastic Surgeon
4.5 out of 5 stars 69 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.