Pilot Study: Precision in Plastic Surgery: Efficacy of Nerve Mapping and Neural Stimulation for Facial Nerve Localization in Permanent Filler Removal

Background: The surgical removal of permanent facial fillers is often complicated by chronic inflammation, tissue distortion, and the risk of facial nerve injury. This pilot case series highlighted the use of intraoperative nerve monitoring (IONM) to enhance the safety and precision of filler removal procedures. Methods: This single-center pilot case series included patients who underwent permanent facial filler removal using IONM to localize and protect the facial nerve branches. Results: Four female patients (mean age 53 y; range: 48-56 y) underwent surgical removal of permanent facial fillers, with concurrent face lifting and intraoperative facial nerve monitoring. Indications included recurrent infection in 2 (50.0%) patients, chronic inflammation in 1 (25.0%) patient, and facial asymmetry in 1 (25.0%) patient. No patients had preoperative facial nerve deficits. The mean operative time was 4.5 hours, and filler removal was successful in all cases. Facial nerve function was preserved in all patients without any transient or permanent dysfunction. Two patients (50.0%) received adjunctive fat grafting (mean volume 20 mL; range: 16-25 mL). Minor complications occurred in 2 (50.0%) patients and resolved spontaneously in both. All patients (100%) reported improved facial contour and resolution of symptoms. Follow-up ranged from 5 to 12 months, with no recurrence of nodules, inflammation, or occurrence of any nerve dysfunction. Conclusions: This pilot case series showed that surgical removal of permanent facial fillers with IONM proved safe and effective, yielding full nerve preservation, high patient satisfaction, and no major complications. However, this approach needs further study to prove its efficacy, safety, and cost-effectiveness.