Will My Facial Nerve Weakness Recover After Cheek Implants?

Q: Dr. Eppley, I had cheek implants recently and developed right after a weakness of my right upper lip and nostril. I was reading up on people that have had similar issues like mine and what other doctors have recommended and can across this (read below). I’ve also read the longer you wait to get the issue checked out the worse the outcome will be if your trying to fix it. So I’m torn on waiting if it lowers my chances of resolving the problem. I’m terrified this is permanent and was wondering if conducting a nerve test would be a smart thing to do. Maybe the nerve just needs to be decompressed, or if it was damaged or cut then nerve grafting would be the way to go. But the longer I wait the less my chances are to fully recuperate to the way I was before. 

What do you think?

‘The usual risks have been well presented by the other physicians. However, based on observed cases, there is a risk for temporary weakness of a cheek or upper lip especially with the larger implants which have to be placed beneath a branch of the facial nerve which is stretched. When and if this happens , Botox therapy can be used for symmetry until the nerve function returns.’  

A: Facial nerve injury is a very rare occurrence after cheek implants as the dissection is done under the muscle where the nerves supply them. But it can happen. In almost all cases complete nerve recovery would be expected.

I would be very careful about what you read and try to interpret about facial nerves injuries…as they are quite different based on where the injury to the nerve occurs and what type of injury that it is. Most of what you are reading refers to a proximal injury to a facial nerve branch, whereas what you have is a distal or terminal branch type of nerve injury. In essence if you draw a line between the corner of your eye and the corner of your mouth what lies towards the ear would be considered proximal and what lies on the nose side of that line is distal. Distal facial nerve injuries, where the nerve fibers are smaller than a human hair, are not treatable by any surgery or other therapy. Time and healing is all that can be done for them. This is particularly true for the distal branches of the buccal nerve which supply the upper lip and nostril. The buccal branch has a particular propensity to recover, unlike many other facial nerve branches, because there is considerable cross connections between these terminal nerve fibers. So even if one little branch is injured, the cross connections will allow other signals to supply what has been lost. This is particularly true in stretch injuries. (which is the only type of injury you could have) Thus it is not true that the longer you wait the worse the chances of recovery are. Waiting is the treatment and the longer you wait (there is nothing else to do) the better the chances of recovery will be. This is a process which is unknown as to how long it will take…it could be days, weeks or even months. Although I would guess some improvement will start within four to six weeks, it could take longer and complete nerve recoveries have been seen out to even a year after the event.

Botox injections can be done on the opposite side for facial symmetry, although if recovery on the affected side starts weeks later, the facial asymmetry will persist until the Botox wears off. (around 4 months) Since facial nerve recovery is usually progressive (starts working a little at a time), I would wait a few weeks or month to see if the nerve will slowly start coming to life. If not, then you can get Botox on the opposite to provide some temporary improvement in facial symmetry with smiling.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry L. Eppley
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Board Certified Plastic Surgeon