Hi Dr Naderi

I hope you can help allay my fears. I am 3 weeks post a triplanar facelift (endoscopic forehead lift, endoscopic midface lift, lower facelift with neck tightening and upper and lower eyelid surgery). Immediately after the surgery my husband noticed that one side of my mouth was drooping and when talking I could tell that my mouth was not moving in sync. The doctor said that this is a rare risk and assured me it should not be permanent but that because of its position below the mouth where there are not many nerves that regeneration will take a long time, possibly 7-8 months. I think he said that the damaged nerve was on the marginal mandibular branch and caused by extreme heat. I was of course very upset and did not want to face friends with this deformity so he injected 25 UV of dysport (botox) one week later and prescribed Trental 400mg and Neurorubine Forte Lactabs twice daily. If the nerve does not regenerate before the botox wears off should I have botox injected again or could this cause more problems? Also, I would really value a second opinion as to the likely timeframe of nerve regeneration (and assurance that this will not be permanent).

Hi,

Your lip droop is most likely due to damage to the marginal mandibular branch of the facial nerve. The fact is that no one can tell what happened to the nerve. Most likely not even your surgeon. When we take off facial cancers or tumors, we look for facial nerve branches and identify them and protect them by avoiding cautery or traction in the area. During a lower facelift or even neck liposuction the MM nerve is at risk but almost no one looks for it. The proper practice is to stay away from its known predicted path or course and to stay in the proper plane of dissection thereby avoiding the nerve. When after surgery nerve damage is seen, it is nearly impossible to know if the nerve was cut accidentally or just traumatized.

If the nerve was traumatized from heat of cautery close to it or from traction then the prognosis is usually good and function should return within 1-3 months.

If the nerve was cut or directly cauterized then it is not as easy to predict its return. In the mid-face area, there are lots of facial nerve branches so the chance of cross innervation is good and you could expect 90% or greater return of function over a 1 year period of time. On the lower face the prognosis is not as good because there are not many nerve branches to cross over and "pick up the slack."

Time will tell. You could certainly see an ENT surgeon for a second opinion which is not a bad idea. Other than that you have to be patient and cross your fingers. Botox and oral medications are not going to significantly help speed up recovery. If anything, Botox should not be done on the same side. It is OK on the other side so to create a more even look if you desire.

Thank you Doctor for your detailed and honest evaluation. I will keep my fingers crossed and get a second opinion from a specialist. I guess I really wanted to know if there was anything different I could be doing at this stage to speed recovery or improve the outcome.

Not much you can do but be patient and seek an ENT's 2nd opinion.