Uncontrollable Facial Twitches After Cosmetic Surgery: Causes and Solutions

Involuntary twitching of the left cheek?

Two years ago, I underwent cosmetic surgery to elevate my cheeks.
(Below are the surgical details provided by my doctor.) After the surgery, my cheeks were quite swollen, and before the swelling subsided, my left cheek was accidentally bumped hard by my one-year-old daughter.
Once the swelling on my left cheek went down (approximately 3-6 months later), I began to experience involuntary fluctuations in my left cheek.
It is not a rapid twitch, and it is not visible externally, but I can distinctly feel a sensation as if there is a worm moving back and forth inside my cheek.
Initially, the movement was quite pronounced, but it gradually decreased in amplitude; however, it has remained constant for over a year now without any cessation.
My plastic surgeon informed me that this is due to nerve hypersensitivity causing involuntary discharges and advised me to massage my cheek to desensitize it.
I have just started massaging, and I am unsure if it will be effective.
Although it does not cause any harm, it has made me quite anxious and led to some physical symptoms.
Therefore, I am eager to know if there are any methods to completely resolve this issue.
I look forward to your response.
Thank you!
Operation summary is as follows:
Preoperative Diagnosis: Aging face
Operative Method: 1.
Endoscopic Temporal Lift 2.
Endoscopic Midface Lift with Endotine Midface Device Fixation
Dissection Planes: Dissection over the temporal area was performed under the superficial temporal fascia (Ramirez's method), extending beyond the upper margin of the zygomatic arch (down to the midface), and the dissection was carried down to the subperiosteal plane.
All dissection was conducted under endoscopic guidance.
Fixation: The superficial temporal fascia in the temporal area was elevated and secured to the deep temporal fascia at a higher position with sutures, while the tail of the Endotine Midface device was also lifted and fixed to the deep temporal fascia around the temporal incision area.

An An, 40~49 year old female. Ask Date: 2014/06/29

Dr. Gao Chunde reply Neurology

Based on the symptom description, it is more akin to facial myokymia, which refers to involuntary muscle twitching of the facial muscles.
This can range from benign nerve hyperexcitability (such as eyelid twitching) to involuntary discharges due to facial nerve damage, and to specific demyelinating lesions or other pathologies in the brainstem.
The first type usually resolves on its own within a few days to weeks and may recur intermittently.
The second and third types require a detailed examination of facial and brainstem-related neurological functions by a neurologist to assess the situation further, determining whether additional neurophysiological or imaging studies are necessary to identify the underlying cause and treatment.

Reply Date: 2014/06/29

More Info

Uncontrollable facial twitches following cosmetic surgery can be a distressing experience, and understanding the underlying causes and potential solutions is crucial for managing this condition effectively. Based on your description, it appears that the involuntary movements in your left cheek may be related to nerve sensitivity or irritation, possibly exacerbated by the trauma from your daughter’s accidental bump during the recovery phase.

Causes of Facial Twitches Post-Surgery
1. Nerve Sensitivity: After cosmetic procedures, especially those involving lifting or repositioning of facial tissues, the nerves in the area can become overly sensitive. This hypersensitivity can lead to abnormal electrical discharges, resulting in twitching or spasms.

2. Trauma: The incident where your daughter bumped your face may have caused additional stress to the already healing tissues and nerves. This could have contributed to the development of the twitching sensation.

3. Scar Tissue Formation: Surgical procedures often lead to the formation of scar tissue, which can sometimes entrap or irritate nearby nerves, leading to involuntary movements.

4. Muscle Fatigue or Imbalance: Post-surgical changes in muscle tone or function can also lead to twitching. If one side of your face is compensating for weakness or altered muscle function, it may result in spasms.

Solutions and Management Strategies
1. Facial Massage: As your surgeon suggested, gentle massage can help desensitize the area and improve circulation. This may reduce the twitching over time. It’s essential to be consistent and gentle to avoid further irritation.

2. Physical Therapy: Consulting with a physical therapist who specializes in facial rehabilitation can provide targeted exercises to strengthen the affected muscles and improve coordination. They can also teach you relaxation techniques that may help reduce anxiety related to the twitching.

3. Medication: In some cases, medications such as muscle relaxants or anti-anxiety drugs may be prescribed to help manage symptoms. However, this should be discussed with a healthcare provider to weigh the benefits against potential side effects.

4. Botulinum Toxin Injections: In certain cases, Botox injections can be used to temporarily paralyze the overactive muscles causing the twitching. This is typically considered when other conservative measures have not provided relief.

5. Neurological Evaluation: If the twitching persists or worsens, it may be beneficial to consult a neurologist. They can perform tests to rule out any underlying neurological conditions that may be contributing to the symptoms.

6. Psychological Support: Given that the twitching has caused you anxiety and physical symptoms, seeking support from a mental health professional may also be beneficial. They can help you develop coping strategies to manage anxiety related to your condition.

Conclusion
While the involuntary movements in your left cheek can be concerning, there are various strategies you can employ to manage and potentially alleviate the symptoms. It’s essential to maintain open communication with your cosmetic surgeon and any other healthcare providers involved in your care. They can guide you through the process and help you find the most effective treatment options tailored to your specific situation. Remember that recovery from cosmetic surgery can take time, and patience is key as you work towards regaining comfort and confidence in your facial appearance.

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