Face lift and Facial Nerve Surgery

Face lift and facial nerve; Botox of the entire face

 

Face lift surgery has few serious complications, but one of them is injury to the underlying facial nerve. The facial nerve is the primary nerve for facial expressions and innervates face muscles. Plastic surgeons must know about face lift and facial nerve surgery .

Here are some articles about facelift surgery.

https://tavmd.com/2013/04/15/face-lift-with-local-anesthesia/

https://tavmd.com/2012/05/06/the-face-lift-windswept-look/

The facial nerve has a long and convoluted course.  It may seem boring to read this anatomy lesson, but you will need to have an idea of the subject so my next blog makes sense—that one is going to be unnerving (could not resist). Your cosmetic plastic surgeon is intimately aware of this anatomy.

 

First, as our facial nerve comes out of our brains, it gives off a few branches (chroda tympani) and stapedial (ear) and travels by the tragus cartilage in front of the ear to a higher level. Our facial nerve then splits into five main branches just in front of the ear but still under the facial muscles and gives a combination of sensation and movement to our faces. The nerve comes out to a superficial level past the pupil area. If a branch is damaged during facelift or facial surgery, it may take days or months before function returns.

 

Branches of the facial nerve

facial nerve

 

facial nerve photo

Deep Facial nerve branches

  • Chorda tympani – taste to front (anterior) 2/3rd of the tongue
  • Submandibular/sublingual gland
  • Stapedial branch – to middle ear stapes muscle

 

Superficial Facial nerve branches

  • Temporal – helps to elevate the eyebrow  
  • Zygomatic – helps the cheek to elevate

          – helps eye closure

         – reflex blinking of lids

  • Buccal – helps the corner of the mouth/cheeks to elevate
  • Marginal mandibular – depresses lower lip muscles
  • Cervical – tightens neck muscles

 

Facelift surgery

During facelift surgery, the skin of the face is elevated above the fat and muscles of the face. The fat and muscles are elevated and held in place with sutures. The skin is then pulled tight. All facelift surgery occurs in a level above the face muscles. The facial nerve runs below the muscles. Injury to the facial nerve during facelift surgery is hence rare if the surgeon stays above the facial muscles. The facial nerve does become more superficial, piercing the facial muscles as it gets closer to the nose. Injury can occur in the central part of the face.

More commonly there is a temporary lack of function of the facial nerve due to the local anesthesia that is placed in the skin of the face for facelift surgery. The anesthesia gives the same results as paralysis of the superficial branches of the facial nerve.

 

Botox and botulinum toxin and facial nerve

Botox treatments give very similar results in some cases to facial nerve injury or decreased function. The botulinum toxin will actually stop some of these facial nerve branches from working. If the botulinum toxin is put in the wrong areas, Botox can lead to serious side effects that will require therapy. This is why Botox is only recommended for specific areas of the face, such as the area between the eyebrows, the crow’s feet and the forehead.

So much for the anatomy lesson—stray tuned for the next blog, which shows someone with facial nerve paralysis!

 

Morad Tavallali, M.D., FACS