Is increased stinging and cold sensation throughout face normal 4.5 months after a facelift and upper eye lid surgery?

Question

I had a standard rhytidectomy, including the tightening of the underlying fascia and muscle and upper blepharoplasty 4.5 months ago. The board certified PS also injected some fat from my neck into the face. I have been experiencing a sensation of coldness (not to the touch of others, though), increased stinging throughout my cheeks, and a tight rubber band-like feeling under my chin and around the ears. Recently, I developed ringing in my ears and it feels like there is a stick in one. Please advise.

Marc Pacifico, MD, FRCS(Plast) · Answer

many thanks for posting your question.It sounds like your face is going through the healing process, with the nerves coming back to life after the surgery. Sometimes, the sensory nerves that have been (necessarily) cut as part of the facelift procedure come back to life with a number of unpleasant sensations, such as tingling, shooting pains, over-sensitivity and more. These normally settle down with time. I find that regular massage of the cheeks and affected area can really help too.I hope this reassures you.

J. Phillip Garcia, MD, FACS · Answer

It is very common and expected to have different sensations in the face after a facelift.  Many patients experience numbness, tingling, crawling sensations, shooting sensations and heat/cold.  This is all part of the sensation returning after the operation and it can last as long as one year with gradual improvement. As far as the tightness this is most likely the result of the operation as the procedure usually tightens a muscle.  The ringing in the ears may be due to decreased hearing due to either wax or blood in the ear canal.  Allow your surgeon to examine you and reassure you. Best of luck.

James H. Rogers, MD · Answer

After a facelift , it is common to experience numbness and areas of decreased sensation. Generally , most of these changes will have resolved by six months postop. As nerve function returns , it is common to experience varying sensations such as burning, tingling, stinging , and hot or cold sensations. Sometimes these changes can take longer to resolve, but infrequently are they permanent.

Anil R. Shah, MD · Answer

Stinging, tingling, and other odd sensations can occur after any surgical procedure particularly around an incision site.  When nerves regenerate, paresthesias or abnormal nerve sensation can occur.  This can take up to a year or longer to fully resolve.  Best Dr. Anil Shah

David Gilpin, MD · Answer

Thank you for your question.  Congratulations on having a facelift and upper blepharoplasty.  I'm sorry that you are having these symptoms after your procedures.  After a facelift, it is not uncommon to have different sensations and numbness in the skin of the face and neck.  In addition, it is not uncommon to have numbness in the ears, as well.  This numbness is almost always temporary, but can take up to 6 months to fully resolve in some cases.  Be sure to discuss your symptoms with your surgeon, but this numbness should resolve with time. I hope that this helps!-David Gilpin

Evan Ransom, MD, FACS · Answer

Thank you for the great question. During a face and neck lift, there the sensory nerves to the skin are often disrupted. These reconnect over time in the great majority of cases. However, during this process, patients may experience some unusual or unexpected sensations. This is frequently described as "pins and needles" or "tingling" or even a brief "shooting pain." These feelings are the result of the little nerve endings rejoining and generally will subside over a few weeks. Changes in your hearing and/or ringing in the ears would not be expected; this should be evaluated with a hearing test and an ear examination. Best of luck and take care!

Zoran Potparic, MD · Answer

Symptoms that you are experiencing are related to recovery of sensation after face lift. In the process of skin flap separation multiple small nerves and nerve endings are cut; as a result patient has numbness of the cheeks, pre-auricular area and frequently part of the ears. Within few weeks injured nerves start growing back and in that process patients experience different sort of sensations including those that you have. It will go away and complete sensation  will return within next few months. Good luck.

Francis Johns, MD · Answer

Thank you for your question.It can take the sensory nerves 6 months or longer before they go back to normal after surgery. The sensations you are describing are not unheard of at this point. The ringing in the ears would be unrelated to surgery, as would the feeling of a foreign body in the ear. I would suggest being evaluated by an ENT for those complaints.

Greg Bran, MD, PhD · Answer

Thank you for your interest. Your facial symptoms are not unusual after a face lift procedure. Some of your facial sensory nerves have been partially disrupted during the operation and it takes weeks for them to get reorganised. It takes weeks but it will surely resolve itself. 
With regards to the ringing in your ear and blocked feeling on one side  you should see an ENT - these symptoms are not connected to your previous facelift and sound more like ear wax blocking your acoustic meatus and a tinnitus. Good luck

Greg Bran MD PhD
Double board-certified Facial Plastic Surgeon 
Member of the European Academy of Facial Plastic Surgery

Member of the American Academy of Facial Plastic Surgery

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many blepharoplasty (eyelid surgery), SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  The more invasive the procedure(s), the longer the recovery.  If you are concerned about things at this point, it would be best to discuss these issues with your surgeon as only he/she knows what was done, how invasive the procedure(s) were and the expected healing time associated with the surgery.  In my experience prolonged recovery is one of the reasons many facelift candidates are seeking minimally, invasive SMAS facelifts that offer a much more rapid healing time.  Perhaps your surgeon has some suggestions on how to minimize the sensations that your are describing.   
 The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
4. Be certain that you choose a facelift procedure that allows you to resume your active lifestyle in a reasonable amount of time.
  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)can be performed in 90 minutes or less, with or without general anesthesiaproper SMAS Imbrication techniqueno incisions within the hair = no hair lossexcess fat can be removed from the face and neckexcess skin removed from the face and neckcheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implantsmost patients fly back home to parts all over the world in as little as 3 days post-op I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Shaping cheeks that are flat or concave in the front (cheek augmentation) with precise placement of a dermal filler or by using silastic cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 When the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
 I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

Is increased stinging and cold sensation throughout face normal 4.5 months after a facelift and upper eye lid surgery?

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