What the research shows
How often it happens. Pooled across many practices, injury to a nerve that moves the face followed fewer than 1 facelift in 100, and permanent injury about 1 in 2,000 (Gandra 2025). In deep plane facelifts, temporary weakness occurred in about 1 patient in 80 and no permanent injury was reported (Koroma 2026).
Most weakness recovers. Most injuries are stretched or bruised nerves rather than cut ones. About 7 in 10 injured patients recovered fully within six months with steroids or physiotherapy, and about 1 in 10 kept some weakness (Arianpour 2025). The same pattern was described decades ago: injury in under 1 percent of cases and return of function in most within six months (Baker 1979).
The lower lip is the usual site. The muscle that pulls the lower lip down is the one surgeons report weakened most often (Pak 2026). After lifts that work on the neck muscle, a weak lower lip often comes from the neck branch of the nerve rather than the jaw branch; the patient can still push the lip out, and every such patient in one large practice recovered within six months (Daane 2003). Nerve mapping in living patients now shows this lip muscle is supplied mainly or partly by the neck branch, which explains the pattern (Har-Shai 2026, Frants 2025).
Where the nerve is at risk. The nerve starts deep and is covered by fascia, but its branches come close to the surface over the chewing muscle and where the jaw branch crosses the facial artery, and thin patients have less cover (Rudolph 1990). The temple branches carry the highest risk, followed by the jaw and cheek branches (Zani 2003). Branch positions on the skin vary from person to person, but their depth relative to the tissue layers is constant, so safety comes from dissecting in the right layer (Roostaeian 2015, Stuzin 2020). Over the cheekbone arch, the forehead branch lies under its own deep fascia and stayed intact after a high SMAS lift (Trussler 2010). The jaw branch dips below the jawline in many people, and the traditional rule of staying 2 cm below the jaw does not reliably protect it (Vrapciu 2026).
The ear nerve. The nerve most often injured in a facelift is the great auricular nerve, which gives feeling to the ear; it is closest to the surface at a fixed point on the neck muscle, which surgeons can mark to avoid it (McKinney 1980, Lefkowitz 2013).
Where surgeons disagree
- Deeper lifts and nerve risk. Pooled studies found more temporary weakness after high lateral SMAS and composite lifts than after plication, and no difference in permanent injury between techniques (Jacono 2019); deep plane studies report no permanent injury (Koroma 2026). Surveyed facial plastic surgeons still tied deep plane lifts to more nerve injury (Pak 2026).
- Reducing the submandibular gland. One surgeon reported temporary lower lip weakness in about 1 gland reduction in 22, all resolved by three months (Mendelson 2015); the same survey linked frequent gland reduction to more nerve injury (Pak 2026).
What is new
- Nerve mapping in living patients shows that dividing the neck muscle lower down spares the branch to the lower lip (Har-Shai 2026, Frants 2025).
- In second facelifts, where scar and thinner tissue make dissection harder, temporary nerve weakness reached about 1 in 8 in some series, though overall complication rates matched first facelifts (Saad 2026).
- Facial nerve monitors are rarely used in facelift surgery (Pak 2026).
What is still unknown
- Whether nerve monitoring during surgery prevents injury (Arianpour 2025).
- The best treatment for the rare injury that does not recover; registries with standard measures are needed (Arianpour 2025).
Key papers
- Baker 1979: nerve injury was rare and usually recovered.
- McKinney 1980: a fixed point on the neck for avoiding the ear nerve.
- Rudolph 1990: measured how deep the nerve lies and where it comes close to the surface.
- Daane 2003: lower lip weakness from the neck branch always recovered.
- Trussler 2010: the forehead branch is protected by deep fascia over the cheekbone.
- Stuzin 2020: the danger zones, defined by tissue layers.
- Jacono 2019: permanent injury did not differ between lift techniques.
- Gandra 2025: the pooled rate of nerve injury after facelift.