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2026, Number 1

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Cir Plast 2026; 36 (1)

Safety recommendations to prevent facial nerve injury in a rhytidectomy

Cuenca-Pardo J, Iribarren-Moreno R, Lira-Álvarez MC

Language: Spanish
References: 46
Page: 26-36
PDF size: 2405.47 Kb.


ABSTRACT

The most frequent complication in facial rhytidectomy is nerve injury. Branches of the facial nerve do not have an exact location relative to palpable or visible facial reference points; furthermore, the number of branches and decussations is variable, while their depth and relationship with facial planes are constant. The key to safety in aesthetic facial surgery is understanding three-dimensional facial anatomy and recognizing the planes through which the facial nerve runs, which are a constant plane. The main safety recommendations include initiating facial skin flap elevation in the anterior portion of the ear within the parotid region, where facial nerve branches are deep. SMAS dissection can also begin in this area and should be performed while maintaining uniform flap thickness. Dissection should be open, with careful hemostasis that allows visualization of structures. Surgeons must be aware of sites where nerve branches may be injured, known as caution or risk zones, located in transition areas where branches move from deep to superficial planes or where they traverse retaining ligaments or penetrate the borders of mimetic muscles such as the zygomaticus or orbicularis oris.


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