Chronic, burning facial pain following cosmetic facial surgery

Painful Complications After Cosmetic Surgery: Management of Peripheral Nerve Injury

BACKGROUND

Aesthetic procedures are among the most common surgeries performed by plastic surgeons. The prevalence of persistent pain remains unknown and underappreciated in the plastic surgery literature.

OBJECTIVES

The purpose of this article was to increase awareness of this problem while describing the diagnostic and management strategies for patients with postoperative pain after aesthetic plastic surgery.

METHODS

A literature review was performed utilizing the PubMed database to identify painful complications of brachioplasty, blepharoplasty, rhytidectomy, abdominoplasty, breast augmentation, mastopexy, and breast reduction. A treatment algorithm was described to guide plastic surgeons presented with patients reporting pain after aesthetic surgery.

RESULTS

Title and abstract review followed by application of inclusion and exclusion criteria resulted in 20 clinical studies for this review, including lateral femoral cutaneous nerve, iliohypogastric nerve, and intercostal nerves after abdominoplasty; median antebrachial cutaneous nerve after brachioplasty; supraorbital, supratrochlear, and infratrochlear nerves after blepharoplasty; greater auricular nerve, auriculotemporal nerve, and zygomaticofacial nerve after rhytidectomy; and intercostobrachial nerve after breast surgery.

CONCLUSIONS

Neuromas can be the source of pain following aesthetic surgery. The same clinical and diagnostic approach used for upper and lower extremity neuroma pain can be employed in patients with persistent pain after aesthetic surgery.

LEVEL OF EVIDENCE: 4

Use of gabapentine (neurantin) for relief of intractable pain developed after face-lift surgery

Complications of rhytidectomy, technically one of the most challenging operations of the aesthetic surgery, have been widely reported in the literature and nerve injuries are one of these possible complications during facial rejuvenation surgery. Beside the injuries of motor branches of the facial nerve, complaints of numbness and development of neuromas due to sensorial nerve injuries were reported in the literature. In this particular reported case, however, complaints of a 52-year-old woman, presented with diffuse intractable pain in her left cheek radiating to the neck and behind the ear after facial rejuvenation surgery, improved dramatically by use of gabapentine. Although there was no apparent neuroma formation on her neck, MRI findings are inconclusive and she had not responded to injection of local anesthetics at all.