Complete Hemifacial Paralysis Post-facelift: Making Sense of a Plastic Surgeon's Worst Nightmare

Abstract

Background Post-rhytidectomy hemifacial paralysis is a frightening clinical condition affecting the proximal facial nerve and most often associated with Bell’s Palsy. Associated symptoms are common and include auditory, salivary, vestibular and gustatory complaints. Objectives To provide increased awareness of post-rhytidectomy hemifacial paralysis secondary to Bell’s Palsy in the plastic surgery community. Methods Following a round-table discussion with the senior author’s plastic surgery colleagues located all over the world, 8 surgeons reported having had first-hand experience with hemi-facial paralysis in patients following facelift. The descriptions of their cases including the preoperative, intraoperative, and postoperative course were collected and reported. Results A total of 10 cases of post-rhytidectomy hemifacial paralysis were analyzed based on results of a clinical questionnaire. Eight of the ten cases involved all facial nerve branches, with two cases sparing the marginal mandibular branch. The vast majority of cases were referred to a neurologist and steroids initiated. Two patients were returned to the operating room for exploration. Associated symptoms reported included pain in the ear, hearing loss, ocular symptoms such as tearing or dryness, vestibular symptoms such as vertigo, changes in taste, and in one patient an electric-shock type sensation to the face. Conclusions Hemifacial paralysis associated with Bell’s palsy following rhytidectomy is a rare but known clinical entity that should be included in the preoperative informed consent process prior to facelift. Current management trends are neurology referral and steroid initiation.