Q: Dr. Eppley, I got Medpor cheek implants that where placed high and lateral extending towards the ears one month ago.While I am very pleased with the result, the surgery caused damage to the facial nerve. Immediately after surgery I couldn´t move my right eyebrow and when I tried to close my right eye, my eye was half open. About 6 hours after surgery I could move my right eyebrow again and my right upper eyelid closed almost completely. Ten days after surgery I noticed that I got water in my right eye when I washed my face, but I didn´t had any problems with dry eyes or any sleeping problems. A friend of mine told me that my right eye is about 2 mm open when I close it and the movement of the right upper eyelid is slightly delayed. I also noticed that while the lower eyelid of the “healthy” left eye touches the iris, the lower eyelid of the right eye is 1 mm below the iris. Fortunately 3 weeks after surgery my eyelid situation improved. The right lower eyelid almost touches the iris, the gap between my closed eyelids is almost not visible (1 mm or less) and I feel the muscle movement of my right upper eyelid growth stronger and stronger. The movement of the right upper eyelid is still slightly delayed. I also have to mention that the whole eyelid problem on my right side is gone in the morning and towards evening it becomes worse. How bad do you think is this kind of nerve damage that I got from surgery and what do you think happened to the facial nerve? Do you think that in my case there is any chance of a complete nerve regeneration or should I learn to live with it? Is there anything I can do to promote nerve regeneration, for example by taking high dosage of B vitamines and exercising the movement of my eyelids or is there anything I should avoid?
A: Your description is classic for a nerve traction or stretch injury after surgery. What was affected was the frontal branch of the facial nerve. This crosses over the zygomatic arch and obviously was affected by the very lateral placement of your cheek implants. I have never seen such a nerve injury after cheek implants but then the very lateral placement of your cheek implants is also uncommon. The goods news is that such a rapid improvement of nerve function after surgery bodes well for complete recovery. I suspect by three months after surgery this will no longer be an issue.
Dr. Barry Eppley