Can Cheek Implants Cause Nerve Damage?

Q: Dr. Eppley,  it’s been exactly 2 months since my cheek implants were inserted and I cannot move my upper right lip & have numbness in the lower cheek area. My upper lip movement has SLIGHTLY increased since the surgery but I’m very concerned that I have permanent nerve damage or lip upper paralysis. In your experience, have you seen any cases where patients get permanent lip/facial paralysis as a result of cheek implant surgery?

A: The intraoral insertion of cheek implants is a subperiosteal pathway to the zygomatic body that lies way below where the buccal branches of the facial nerve lie in the more superficial overlying muscles. The dissection does expose the large  infraorbital nerve (2nd division of the trigeminal nerve) which is a sensory nerve that exits the bone below the infraorbital rim and usually transects the small zygomatico-orbital nerve branch (sensory nerve branch) as the dissection crosses the zygomatic body.  Thus it is very common to have some temporary numbness to the cheek area and even the upper lip which can take several months to resolve. It is very difficult to get motor weakness/paralysis of the buccal facial nerve branches which supply movement to the upper lip given where the nerve lies and where the deeper dissection is done. If weakness is present, it is likely due to a traction injury rather than nerve branch transection. In addition, there are numerous branches of the buccal nerve which have some cross-innervation. This means that eventual return of full lip function is assured. The return of nerve function may be slow and the fact that you are seeing some upper lip movement indicates that the recovery process is ongoing. It may take up to six months or more for complete function to return.

Dr. Barry Eppley