Facial Surgery Complications: Inability to Smile and Eye Closure Issues

Q: Facial Surgery Complications: Inability to Smile and Eye Closure Issues

Hello, Miss： You mentioned the symptoms of "a crooked smile and the inability to close the lower eyelid," which may indicate inflammation of the facial nerve. <br>During the acute phase, due to nerve damage, improvement of symptoms may take some time. <br>The use of corticosteroi

After the facelift surgery, the left side of the face is unable to express emotions?

I underwent a three-layer facelift surgery on September 19, and now the left side of my face cannot lift the corner of my mouth, causing my smile to be lopsided.
The lower eyelid cannot close properly, relying instead on the upper eyelid to close, but it doesn't close completely, resulting in a sensation of soreness and coolness in my eyes.
In short, I cannot make any facial expressions on the left side of my face.
The surgeon mentioned that the fascia is very tight, causing the nerves within the fascia to become elongated and narrowed, which hinders the conduction of nerve impulses, thus preventing facial expressions.
Additionally, I consulted a neurologist who prescribed small white round steroids for me, to be taken three times a day, four pills each time.
I have been taking them for two days and was about to start the third day today, but there has been no improvement.
Is it possible that the surgery damaged the nerves? However, the surgeon assured me that they used nerve monitoring equipment and told me not to worry at all.
Despite the surgery and taking steroids, there has been no improvement, and I am still very concerned.

Weiwei, 40~49 year old female. Ask Date: 2023/10/04

Dr. Jiang Junyi reply Neurology

Hello, Miss: You mentioned the symptoms of "a crooked smile and the inability to close the lower eyelid," which may indicate inflammation of the facial nerve.
During the acute phase, due to nerve damage, improvement of symptoms may take some time.
The use of corticosteroids in the first week is primarily to control inflammation and reduce the extent of nerve damage.
Other treatment options include medications such as vitamins and agents to improve blood circulation, as well as therapies like electrical stimulation, acupuncture, massage, low-level laser therapy, infrared irradiation, shortwave therapy, and facial muscle exercises.
If symptoms persist, hyperbaric oxygen therapy may be considered as an out-of-pocket option.
Aside from corticosteroids, there is insufficient evidence to support the effectiveness of other treatment methods.
It is recommended to take vitamin B complex as an adjunct.
I suggest you consult a neurologist for discussion and treatment.
Thank you for your inquiry, and feel free to discuss further.
Wishing you good health, peace, and happiness.
Dr.
Jiang Junyi, Department of Neurology, Taoyuan Medical Center.
For more information on facial nerve paralysis, you can listen here: https://www.youtube.com/watch?v=eyeMD2jNwI8&t=238s

Reply Date: 2023/10/04

More Info

Facial surgery, particularly procedures like facelift surgery, can lead to various complications, including issues with facial expressions such as the inability to smile or close the eyes properly. Your experience of having difficulty with the left side of your face, where the mouth does not elevate and the lower eyelid does not close completely, is concerning and warrants careful evaluation.

The complications you are experiencing may indeed be related to nerve involvement during the surgical procedure. The facial nerve, which controls the muscles of facial expression, can be affected by surgical manipulation, especially if the surgery involves significant lifting or repositioning of the skin and underlying tissues. The surgeon's explanation regarding the fascia being pulled tight and the nerve becoming elongated or narrowed suggests that there may be some degree of nerve compression or irritation, which can impede normal nerve function and lead to the symptoms you are describing.

It is important to understand that while nerve monitoring during surgery can help reduce the risk of nerve injury, it does not eliminate the possibility entirely. Nerve injuries can occur due to direct trauma, stretching, or ischemia (lack of blood flow) during surgery. In some cases, these injuries may be temporary and improve over time, but in other instances, they can result in lasting deficits.

The use of corticosteroids, as prescribed by your neurologist, is a common approach to reduce inflammation and swelling around the affected nerves, which may help in recovery. However, the lack of improvement after a few days of treatment can be disheartening. It is crucial to maintain open communication with your healthcare providers, including both your surgeon and neurologist, about your concerns and the lack of progress.

If you continue to experience these symptoms without improvement, it may be beneficial to seek a second opinion from a specialist in facial plastic surgery or a neurologist with experience in facial nerve disorders. They can perform a thorough examination, possibly including imaging studies, to assess the status of the facial nerve and determine if there are any additional interventions that could be beneficial.

In summary, the complications you are experiencing following your facelift surgery could be related to nerve involvement, and while some recovery may occur over time, it is essential to monitor your symptoms closely. If there is no improvement, further evaluation and possibly additional treatments may be necessary. Your concerns are valid, and seeking further medical advice is a prudent step in addressing these complications.

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