Can Vth cranial nerve be damaged in SMAS procedure?

I have symptoms consistent with damage to nerve V (V1 & V2) after SMAS. Gritty, burning watery eye, hyperaesthesia of lids, temple, cheek and nasal lining, corner of mouth feels numb and damp. Eye feels tethered. Scar is painful around tragus. I can feel 'something' above zygoma on affected side, if I press on that area there is light popping. Neurontin not helped and I'm distressed at times by symptoms. Should I ask PS to lift scar and look to see if he can investigate/ rectify the problem?

Doctor Answers 3

SMAS face lift - now I have nerve damage

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Thank you for asking about your SMAS face lift.

  • I am so very sorry you appear to have trigeminal (V cranial nerve) damage after your face lift.
  • When was the surgery done? How soon afterwards did the symptoms appear?
  • Does your surgeon know about this problem? 
  • You should see your plastic surgeon, show her/him the area across the zygoma that you can feel.
  • Discuss exploration of the area.
  • But it seems to be affecting so many areas of the nerve - temple, upper and lower lids, an nose, mouth and ear -  that one has to wonder if there is another cause.
  • Ask for an explanation of how the SMAS was done and if it can explain your symptoms.
  • If not, you should certainly see a neurologist (if you haven't already) and consider an MRI or CT scan to make sure there is not another explanation.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Paresthesias after surgery

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I hate to hear what is happening to you after your surgery.  It is rather uncommon to have CN V nerve injury after even an extended SMAS lift.  Without being in the operating room or having access to your records, it is hard to find out exactly what went on.  As was mentioned before, depending on how the SMAS was suspended and where it may also give us clues as to what can and can't be done.  At this point, it is best to contact your PS and explain to them what is going on.  Hopefully they can be forthright with you and have a better idea of why this could be going on and help you get better.  It's also important to know when your surgery was - the fact that these areas "don't feel dead" is a great sign - there is still nerve conduction and likely will resolve with time.  Best of luck.

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 16 reviews

Nerve pain

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I'm so sorry you are having problems after your surgery.  I assume you have discussed this with your surgeon and if not, it is imperative that you do.  While trigeminal nerve injury is rare in facelift, it is important to know what SMAS procedure was done.  If suspension of the SMAS was done along the Zygomatic or cheekbone, the. It is possible that the nerve could be injured.  But understand, I do not have access to the operative notes. Your surgeon will know best what course to take.  Also, if the dysesthesias, or nerve sensations, are less than6 weeks from surgery, it may be best to wait.  I hope this helps and good luck

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