One eye not blinking fully. Is not being able to blink completely normal after surgery?

Question

I am day 12 after a deep plane face lift, lower eyelid surgery with fat repositioning and rhinoplasty. My smile on my left side is slightly asymmetrical but only slightly. What is worrying me is that I am having trouble with my left eye. It is not blinking fully and I can't wink with it. I have been using preservative free eye drops but they seem to be irratating my eye more. Is not being able to blink one eye completely normal after surgery? Does it usually resolve on its own? What do you recommend I do?

Alexander Donath, MD, FACS · Answer

At 12 days out you are still fairly early and will likely see improvement. Have you already discussed this with your surgeon? If you can close your eyes fully (have someone else confirm this) then that is reassuring but if you cannot close the eye fully you need to use lubricating eye ointment while sleeping to prevent drying.Hope that helps and best wishes, Dr. Donath

Brian M. Harmych, MD, FACS · Answer

Thank you for shearing or questions and concerns.  Subtle asymmetries and muscle movements are very common after surgery.  In most cases, the asymmetry and movement is due to swelling and not true nerve injury fortunately, most nerve injuries are temporary and not permanent.  I would be curious to know how you're doing now.  I hope everything is going well at this point.

Benjamin C. Marcus, MD · Answer

Deep plane facelifts are great. The one issue is that there is a slightly higher risk of stretching the facial nerve. This can lead to slight asymmetry in the facial movement. The key thing is that if the main branches of the facial nerve are working (and it sounds like that they are) it will recovery in time.

Carlos L. Wolf, MD · Answer

While most  patients don't have asymmetry after facelift surgery some may. The asymmetry may be due to mild inflammation or residual effect of the local anesthesia on the nerve. in your case the trouble with blinking may be a problem call logophthalmia. usually this resolves in 3 to 4 weeks. Consult your doctor and let him know you're having this problem and he may reassure you as well.

Akshay Sanan, MD, FACS · Answer

Dear ssbs1,
Thank you for asking this question. Blinking may be impacted after surgery because of the eye muscles healing after lower eyelid surgery. It is also possible the nerve that controls eye muscle movement is stretched during facelift surgery. This can take weeks to improve. It is very rare that this problem remains permanent. Just make sure your eye is fully closed at night; if it isn't, you will need to tape the eye shut at night. The same applies for the asymmetry of the smile. This is likely due to the fact that the nerve that controls your smile has been stretched from the surgery and swelling. It should improve on its own with time. I recommend you follow up with your surgeon regularly. I hope this helps answer your questions.
All the best,Dr. Sanan, MDAkshay Sanan MD Facial Plastic SurgeryDouble Board CertifiedStanford University Trained

Kaete A. Archer, MD · Answer

It sounds like you are having some nerve weakness around the mouth (asymmetrical smile) and the eye (incomplete blink).  Nerve weakness after surgery, especially facelifting surgery, is not uncommon.  The weakness may be due to nerve stretching, nerve irritation, swelling of surrounding tissue, amongst others.  The key is to stay in close communication with your surgeon's office to monitor your progress after surgery.  Usually this type of weakness is temporary and patients recover full function of the nerve.  It does take some time so you have to have patience.  
There are many types of eye drops and sometimes patients can develop a sensitivity.  In that case, I would contact your surgeon's office to see if he/she recommends a certain kind and let them know what's going on.  If your eye doesn't close all the way, you want to make sure you are protecting the eye at nighttime with lubrication gel, taping, eye humidity chambers to keep the eye moist at night and avoid dryness and exposure keratitis.  If you notice any concerns, best to contact your surgeon's office.

Andrew G. Silver, MD · Answer

To start, it sounds like at least one of your nerves isn't functioning perfectly or that the muscle is not working. This can be caused by swelling and irritation of the nerve, and is unlikely to be permanent. At this point, the most important thing that you can do is to work with your surgeon to keep the eye well moisturized. It is unlikely that the eye drops are causing the irritation, and much more likely that if the eye is not closing appropriately that you are seeing irritation from dryness. I would definitely go talk with your surgeon. They may be able to show you eyelid stretches, how to tape the eye closed, or may have other suggestions on gels/ointments which are better at providing moisture than drops.hope this helps!dr. silver

Michael Zenn, MD · Answer

The facial nerve controls the muscles around the eye that control blinking (orbicularis occuli) and there are generally a few nerve branches that innervate those muscles so weakness is unusual and permanent blinking problems is quite rare.  Make sure your eye does not get too dry and things should improve over time.
Dr. Z

Jeffrey Jumaily, MD · Answer

The eye blinking issue could be due swelling in the muscles from the blepharoplasty or a nerve conductive. The nerve problem is often temporary but can take several weeks to resolve. Permanent injury to the nerve is rare. Keep your eyes lubricated with drops and ointment to prevent it from drying. Follow up with your doctor to check on it.

Summit Kundaria, MD · Answer

ssbs1,
Thanks for the question.  It sounds like you have some weakness of your left facial nerve in multiple branches after your deep plane facelift, as manifested by an asymmetric smile and weak blink.  While this is not the experience of all patients after a facelift, it is also not rare, and is usually due to some inflammation around the nerve or some stretching during the surgery.  This is something that should improve with time and also be discussed with your surgeon, as they need to monitor this and be aware.  Your prognosis for a full recovery is good because the nerve is still working (you don't have complete paralysis of the facial nerve), which means that the nerve itself is still intact, just not transmitting signals with the same strength as before surgery.  As the rest of your face, this will heal with time.  Good luck!

One eye not blinking fully. Is not being able to blink completely normal after surgery?

Answers (11)

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