Facial Nerve Palsy and Cheek Sagging After Face Contour Surgery: Can You Recover?

The questions patients ask most during face contour surgery consultations are when the swelling will go down, and whether cheek sagging or facial nerve palsy can be reversed if it happens. The short answer from the surgeon in the video: some cheek sagging can occur, and as long as the nerve is not completely severed, palsy usually resolves. Here is what's worth knowing before surgery, in order.

Swelling and getting back to daily life

To be honest, I tell patients it takes about a year for the swelling to go away completely.

Full resolution takes a long time, but the period when swelling actually gets in the way of daily life is much shorter. Acute swelling lasts one to two weeks, and by three to four weeks most people meeting you for the first time won't notice anything unusual. Patients who travel from overseas sometimes go shopping the day after surgery, and returning to work is technically possible, but the surgeon recommends giving yourself about a week. After that week, normal daily activities are fine.

Why do cheeks sag?

When bone volume is reduced, the skin that covered it can't fully re-drape and adhere, so the excess skin can look saggy. Two factors were named as influencing cheek sagging:

• Age: skin re-adheres well in younger patients, so sagging is less of an issue; from the mid-30s on, there tends to be a bit more sagging.
• Amount of bone removed: the more bone is reduced, the greater the effect.

Is removing more bone always better?

Reducing as much as can safely be reduced is reasonable to a point, but that amount differs from person to person, and there are clear limits.

More important than how much you reduce is the shape. Making the face smaller matters, but the facial contour has to look good.

The cheekbones can only be moved in by a set amount, and for the jaw, the safe range of reduction is determined by measuring the height of the nerve. In other words, the heart of a face contour surgery consultation is not removing as much bone as possible, but deciding how to shape the contour within that set range.

The myth that shaved bone grows back

Some patients feel their bone has grown back after surgery, but bone does not actually regrow. According to the surgeon, that impression comes from soft tissue sagging or lingering swelling.

Can facial palsy recover?

The complication surgeons guard against most in face contour surgery is nerve-related. The jawbone contains a tunnel that a nerve runs through, and protecting that nerve is critical. When palsy occurs after surgery, it is usually because this nerve was injured, and as long as it was not completely severed, it almost always recovers. If the nerve is injured to the point of being completely severed, it may not recover.

That's why the surgeon stresses that careful pre-operative planning matters more than anything. If you're considering face contour surgery, first check the contour that suits your face and where your nerves are, rather than focusing on how much to reduce.