The safety of the facial nerve is perhaps the most important aspect of facelift surgery.
The facial nerve exits the stylomastoid foramen and enters the core of the parotid gland. Within the parotid gland it bifurcates into an upper and lower division. It further divides into 5 main branches including the frontal, zygomatic, buccal, marginal mandibular and platysmal. Permanent iatrogenic facial paralysis is rare due to the extensive arborization of the facial nerve branches. The frontal branch is a terminal branch with limited arborization. Injury to the frontal branch has the highest risk of causing permanent paralysis.
The overall risk of permanent facial nerve paralysis in standard rhytidectomy is between 0.53% to 2.6%.There have been very few reports in the literature regarding the risk for facial nerve injury associated with more invasive facelifting procedures. The “short-flap SMAS rhytidectomy” significantly limits the risk for facial nerve injury by limiting facial subcutaneous and SMAS dissection.
1 Excerpts from Azizzadeh et al: “Master Techniques in Facial Rejuvenation”
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