Q: I had inferior orbital rim implants done with a midface lift about 6 weeks ago. It has left me with upper lips on the right side that I cannot purse and numbness in my top front teeth and extending up my nose to my eyes. I am also numb above the implant on the right side. I also had a blepharoplasty. My muscles of my lip don’t function right so my lip hangs down a bit and I have to be careful not to bite it. I can’t spit or whistle right. The muscles that lift the right side of my nose and face don’t work right so one side goes up higher than the other. The implant was put in so that part of it sticks up like the screw wasn’t seated well so i can feel the edge and see its edge in the mirror. The surgeon says he’ll fix it but there is still so much trauma in my face that I don’t know if it will ever resolve and I don’t want to make it worse! I know you don’t know me but I need advice on how to proceed and if this teeth numbness, etc. is normal. Should I wait until my face settles down?
A: The combination of a midface lift, lower blepharoplasties, and orbital rim implants does impose a fair amount of trauma to the midfacial area. It does take more than a few weeks for the feeling and lip and nose movement to return to normal. If this was done in the usual fashion, the lower blepharoplasties was the route through which the orbital rim implants were placed and incisions were done inside the mouth under the upper lip to assist with the midface lift.
The combination of orbital rim implants and the intraoral dissection works around the infraorbital nerves which comes out just under the lower orbital rim. This nerve supplies the feeling to your lip, nose and cheek. It is normal for some temporary numbness to occur afterwards due to the trauma around it. It should be gradually improving and I would expect less numbness each and every week at this point. It should take no longer than three months or so to completely return. If the numbness is not improving by the week, there is the possibility that the implant may be impinging on the nerve. If the other side is completely different in the recovery and much further along, this becomes a real possibility.
Feeling the edge of the implant or the screw is not likely to become less noticeable with time. I believe this is the implant on the same side as the lip and nose numbness and movement concerns. The combination of the above suggests that orbital rim implant adjustment may be needed. Since this is done through the lower blepharoplasty incision, there would be no added trauma to the recovering area below the implant.
As a general philosophy, you wait on a revision when it appears that time is continuing to make progress. When time no longer is making any difference, and the operated area still has problems, then revisional surgery can proceed.
Dr. Barry Eppley