NZb6Air
Kraken
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PFPP = Post–Face Lift Facial Paralysis
FN = Facial Nerve
It's fucked up cause it's this nerve & its branches that control your facial expressions (facial muscles), taste (anterior 2/3s of tongue), tearing up (lacrimal glands) and salivating (some salivating glands)
and you'll get some type of devastating paralysis depending on which branches get compromised
It does happen in facial lifts because that's how it's done :
Pic 1 : Scissors dissection separates the skin flap with the attached malar fat pad from the underlying orbicularis, which has been identified laterally. The dissection proceeds caudally (towards the tail or downward) and medially over the origin of the zygomaticus muscle.
Pics 2 & 3 : Suturing of the lateral edge of the undermined malar fat pad to the fascia over the malar eminenece. The traction on the fat pad is with sulficitent tension to flatten the nasolabial fold (which is like the goal of this shit
/ old + non recessed niggas only tho).
Last pic : The point of suture fixation of the malar fat pad is indicated along a vector perpendicular to the nasolabial crease. The lateral arrow indicates the vector of maximum tension placed on the skin-flap closure.
¹
and btw patients with minimal subcutaneous fat or who undergo secondary face lift have higher risk for FN injury² and the the buccal branch is the most commonly injured branch³ (which will lead to massive asymmetry, loss of facial expression, inability to speak and eat, etc.) they do have ways to tell though, making it a skill issue :
le danger zone⁴
so it's rare i.e. 0.1% for permanent FN ("One must remember, however, that the rates in the literature are based on selfreported retrospective case series by highly experienced surgeons and therefore likely represent an incidence that is below average." Roostaeian et al. 2015 ) so there are a lot of botches from niggermaxed surgeons that go under the radar, in fact : PFFP represents 11% of allegations raised in face lift malpractice (botch) litigation⁵
I made this thread though cause there's this paper that just came out in the Plast. Reconstr. Surg. journal that reviewed 20 years of managing PFFP post-op.
Results :
A total of 25 patients (out of the approximately 5000 patients presenting to a tertiary care FN center) who experienced PFFP were referred for evaluation over the past 20 years. Eight patients required FN exploration (surgical examination basically), 6 of whom underwent nerve repair; all recovered to some degree, with 50% achieving essentially normal facial function. Fourteen patients underwent nonsurgical management, including physical therapy, chemodenervation, and filler therapy. Of these nonsurgical patients who were not lost to follow-up, 50% achieved normal facial function and 42% achieved nearly normal facial function. The single patient who had no spontaneous improvement presented outside the reinnervation window and was not an operative candidate.⁶
Which is huge especially considering these are all old niggas : average age at time of face lift was 62 years (range, 33 to 76 years).
B/a's :
So it's never over basically
¹Owsley, J. Q. (1993). Lifting the malar fat pad for correction of prominent nasolabial folds. Plastic and Reconstructive Surgery, 91(3), 463–474.
² Roostaeian J, Rohrich RJ, Stuzin JM. Anatomical considerations to prevent facial nerve injury. Plast Reconstr Surg.2015;135:1318–1327.
³Stuzin JM. MOC-PSSM CME article: face lifting. Plast Reconstr Surg. 2008;121:1–19.
⁴Hwang, K., Cho, H. J., Battuvshin, D., Chung, I. H., & Hwang, S. H. (2005). Interrelated buccal fat pad with facial buccal branches and parotid duct. Journal of Craniofacial Surgery, 16(4), 658–660. https://doi.org/10.1097/01.SCS.0000157019.35407.55
⁵Kandinov A, Mutchnick S, Nangia V, et al. Analysis of factors associated with rhytidectomy malpractice litigation cases. JAMA Facial Plast Surg. 2017;19:255–259.
⁶Kaufman Goldberg, T., McGonagle, E. R., & Hadlock, T. A. (2024). Post–face lift facial paralysis: A 20-year experience. Plastic and Reconstructive Surgery, 154(4), 748–758. https://doi.org/10.1097/PRS.0000000000011226
FN = Facial Nerve
It's fucked up cause it's this nerve & its branches that control your facial expressions (facial muscles), taste (anterior 2/3s of tongue), tearing up (lacrimal glands) and salivating (some salivating glands)
and you'll get some type of devastating paralysis depending on which branches get compromised
It does happen in facial lifts because that's how it's done :
Pic 1 : Scissors dissection separates the skin flap with the attached malar fat pad from the underlying orbicularis, which has been identified laterally. The dissection proceeds caudally (towards the tail or downward) and medially over the origin of the zygomaticus muscle.
Pics 2 & 3 : Suturing of the lateral edge of the undermined malar fat pad to the fascia over the malar eminenece. The traction on the fat pad is with sulficitent tension to flatten the nasolabial fold (which is like the goal of this shit
/ old + non recessed niggas only tho).Last pic : The point of suture fixation of the malar fat pad is indicated along a vector perpendicular to the nasolabial crease. The lateral arrow indicates the vector of maximum tension placed on the skin-flap closure.
and btw patients with minimal subcutaneous fat or who undergo secondary face lift have higher risk for FN injury² and the the buccal branch is the most commonly injured branch³ (which will lead to massive asymmetry, loss of facial expression, inability to speak and eat, etc.) they do have ways to tell though, making it a skill issue :
le danger zone⁴
so it's rare i.e. 0.1% for permanent FN ("One must remember, however, that the rates in the literature are based on selfreported retrospective case series by highly experienced surgeons and therefore likely represent an incidence that is below average." Roostaeian et al. 2015 ) so there are a lot of botches from niggermaxed surgeons that go under the radar, in fact : PFFP represents 11% of allegations raised in face lift malpractice (botch) litigation⁵
I made this thread though cause there's this paper that just came out in the Plast. Reconstr. Surg. journal that reviewed 20 years of managing PFFP post-op.
Results :
A total of 25 patients (out of the approximately 5000 patients presenting to a tertiary care FN center) who experienced PFFP were referred for evaluation over the past 20 years. Eight patients required FN exploration (surgical examination basically), 6 of whom underwent nerve repair; all recovered to some degree, with 50% achieving essentially normal facial function. Fourteen patients underwent nonsurgical management, including physical therapy, chemodenervation, and filler therapy. Of these nonsurgical patients who were not lost to follow-up, 50% achieved normal facial function and 42% achieved nearly normal facial function. The single patient who had no spontaneous improvement presented outside the reinnervation window and was not an operative candidate.⁶
Which is huge especially considering these are all old niggas : average age at time of face lift was 62 years (range, 33 to 76 years).
B/a's :
So it's never over basically
¹Owsley, J. Q. (1993). Lifting the malar fat pad for correction of prominent nasolabial folds. Plastic and Reconstructive Surgery, 91(3), 463–474.
² Roostaeian J, Rohrich RJ, Stuzin JM. Anatomical considerations to prevent facial nerve injury. Plast Reconstr Surg.2015;135:1318–1327.
³Stuzin JM. MOC-PSSM CME article: face lifting. Plast Reconstr Surg. 2008;121:1–19.
⁴Hwang, K., Cho, H. J., Battuvshin, D., Chung, I. H., & Hwang, S. H. (2005). Interrelated buccal fat pad with facial buccal branches and parotid duct. Journal of Craniofacial Surgery, 16(4), 658–660. https://doi.org/10.1097/01.SCS.0000157019.35407.55
⁵Kandinov A, Mutchnick S, Nangia V, et al. Analysis of factors associated with rhytidectomy malpractice litigation cases. JAMA Facial Plast Surg. 2017;19:255–259.
⁶Kaufman Goldberg, T., McGonagle, E. R., & Hadlock, T. A. (2024). Post–face lift facial paralysis: A 20-year experience. Plastic and Reconstructive Surgery, 154(4), 748–758. https://doi.org/10.1097/PRS.0000000000011226
