Keywords: nerve damage facelift, facelift safety medical patients
A SMAS facelift (Superficial Musculoaponeurotic System facelift) is one of the most advanced and effective facial rejuvenation procedures available. However, because it involves lifting and repositioning the deeper layers of the face, it carries some risk—particularly to the facial nerve branches that control expression. For medical patients with a history of facial nerve conditions, these risks may be higher and require specialized consideration.
If you’ve experienced Bell’s palsy, previous facial trauma, or nerve injuries, it’s essential to understand how these factors impact the safety of a facelift. This article explains what you need to know about nerve damage during facelift surgery and how surgeons ensure facelift safety for medical patients with complex histories.
Understanding the Facial Nerve and Its Role in Facelift Surgery
The facial nerve (cranial nerve VII) controls the muscles of facial expression. It travels through the face in multiple branches:
- Temporal (forehead and brow)
- Zygomatic (cheeks and lower eyelid)
- Buccal (upper lip and nose)
- Marginal mandibular (lower lip)
- Cervical (neck and platysma)
During a SMAS facelift, the surgeon dissects near or around these branches. Although permanent facial nerve injury is rare in the hands of an experienced facial plastic surgeon, temporary weakness or numbness can occasionally occur.
Who Is at Higher Risk for Facial Nerve Injury?
Some patients have pre-existing conditions or medical histories that may place them at a slightly higher risk for nerve-related complications during a facelift.
1. History of Bell’s Palsy
Patients with prior Bell’s palsy, even if resolved, may have residual facial weakness or abnormal nerve regeneration. This may:
- Alter normal nerve anatomy
- Make nerves more susceptible to trauma
- Require a modified surgical approach to avoid areas of vulnerability
Surgeons will typically review past medical records and assess current facial symmetry and muscle function.
2. Previous Facial Trauma or Surgery
Patients with a history of facial fractures, burns, or prior cosmetic surgeries (e.g., cheek implants, facial nerve decompression) may have:
- Scar tissue or altered nerve pathways
- Higher risk of nerve entrapment or poor healing
- Asymmetrical anatomy, which can affect surgical dissection planes
3. Neurological Disorders
Conditions like multiple sclerosis, stroke, or neuropathy can make the facial nerves more fragile or responsive to surgical stress. These patients require a thorough pre-op neurological evaluation.
How Surgeons Reduce the Risk of Nerve Damage
For patients with higher risk profiles, surgeons take specific precautions to minimize the chance of nerve injury:
Pre-Operative Planning:
- Detailed facial nerve mapping through physical examination and, in some cases, imaging
- Preoperative photography and muscle testing to establish baseline facial function
- Review of all prior surgical records and neurologist reports
Intraoperative Techniques:
- Use of magnification (loupes or microscope) to visualize nerve branches
- Blunt dissection techniques in high-risk zones (e.g., near the marginal mandibular branch)
- Avoidance of deep dissection in areas with known nerve vulnerability
- Nerve monitoring in select cases, especially if previous paralysis or trauma has occurred
Postoperative Monitoring:
- Immediate assessment of facial movement in recovery
- Scheduled follow-up to track nerve recovery or detect delayed weakness
- Referral to neurology or physical therapy if signs of nerve dysfunction appear
Temporary vs. Permanent Nerve Effects
In most facelift cases where nerve symptoms occur, they are temporary and resolve within weeks to months. Common examples include:
- Weakness in the corner of the mouth (marginal mandibular nerve)
- Forehead asymmetry or brow droop (temporal branch)
- Cheek numbness or stiffness
Permanent facial nerve damage is extremely rare (<1% in experienced hands) and often the result of deep dissection, aggressive tissue handling, or pre-existing anatomical issues.
Key Questions to Ask Your Surgeon
If you have a complex medical or nerve history, ask your facial plastic surgeon:
- “Do you have experience operating on patients with facial nerve issues?”
- “Will my history of [Bell’s palsy, surgery, trauma] affect my facelift plan?”
- “Can we use nerve monitoring during surgery?”
- “What is the protocol if I experience facial weakness after surgery?”
Final Thoughts
While the risk of nerve damage during a facelift is low, patients with a history of nerve issues or complex medical conditions must be evaluated with extra care. For these individuals, facelift safety depends on:
- Choosing a board-certified, experienced facial plastic surgeon
- Providing a full medical and surgical history
- Following a carefully tailored surgical plan and recovery protocol
If you’re a medical patient with concerns about nerve safety during a SMAS facelift, rest assured that with the right expertise and preparation, excellent results can still be achieved—safely and successfully
