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

Area of Science:

• Plastic Surgery
• Neurology
• Facial Nerve Anatomy

Background:

• Postrhytidectomy hemifacial paralysis affects the proximal facial nerve, frequently associated with Bell's palsy.
• Symptoms can include auditory, salivary, vestibular, and gustatory complaints.

Purpose of the Study:

• To increase awareness of hemifacial paralysis following rhytidectomy, specifically when secondary to Bell's palsy, within the plastic surgery field.
• To highlight the importance of including this rare complication in patient informed consent prior to facelift surgery.

Main Methods:

• A roundtable discussion was conducted with experienced plastic surgeons globally.
• Eight surgeons shared firsthand experiences with hemifacial paralysis in patients post-facelift.
• Case details, including preoperative, intraoperative, and postoperative information, were collected and analyzed.

Main Results:

• Ten cases of postrhytidectomy hemifacial paralysis were reviewed.
• Most cases involved all facial nerve branches; two spared the marginal mandibular branch.
• Common management included neurology referral and steroid administration; two patients underwent surgical exploration.

Conclusions:

• Hemifacial paralysis associated with Bell's palsy after rhytidectomy is a rare but recognized complication.
• This condition should be part of the informed consent discussion before undergoing a facelift.
• Current treatment emphasizes neurological consultation and corticosteroid therapy.