Q: Dr. Eppley, I have concerns about cheek implants that I had placed about six weeks ago. My cheek implants were Medpor implants that were screwed into place. What I am worried about is that I have numbness of my left lip and cheek ever since the surgery. I thought it would be gone by now but it hasn’t. Is this normal? Also, it feels extremely tight around my nose. I think all of the swelling has gone away so I thought they would feel more normal by now. What do you think? Thanks.
A: Depending upon the style, size and location of the cheek implants, they likely extend around the infraorbital nerve which comes out of the bone just below the rim of the eye socket. This is a big nerve that is responsible for the feeling of the skin around the nose, upper lip and teeth. (but not movement) When cheek or midface implants are placed around this nerve, it would be common to have a period of numbness to the areas that the nerve supplies. The key about this numbness is whether it is improving or not. If there has been some gradual improvement in the amount of numbness six weeks after surgery, then it is likely going to go away in a few more months. If it is just as numb today as it was the first week after surgery, the implant may be putting pressure on the nerve and may need to be repositioned. Screw fixation of cheek implants can sometimes be a double-edged sword. The implant is rigidly fixed into place and if it is leaning up against the nerve, there is no relief from the pressure of the implant.
As for the tightness of the face, this is a feeling that should go away as the swelling subsides and the overlying tissues adapt to the ‘push’ of the implant. Since the implant and the bone on which it sits is rigid, the overlying tissues must adapt to them. As a general rule, you should not judge the look and feel of a cheek implant for at least 3 months after surgery to these tissues time to relax. It is also possible that the tightness is because the implant is too big, so you need to see how it looks as the swelling goes away.
Dr. Barry Eppley