The patients developed facial weakness after injections associated with the “elf ear” aesthetic and showed improvements following nerve decompression surgery.
Facial paralysis after filler injected behind the ear affected 17 patients whose cases were reviewed by surgeons in Beijing. All developed weakness on one side of the face immediately after receiving hyaluronic acid injections.
The injections were given in an area used for an aesthetic look sometimes called “elf ears”, which aims to make the ears project slightly further from the head.
After four weeks of non-surgical treatment without improvement, all 17 patients underwent surgery to relieve pressure on the facial nerve. Their facial movement and symmetry improved afterwards, according to the study published in Aesthetic Plastic Surgery on 21 October 2026.
However, the study did not compare surgery with continued non-surgical care. It cannot establish how much of the patients’ recovery was due to the operation.
What are “elf ears”?
The term “elf ears” describes an aesthetic look in which the ears appear more prominent when viewed from the front.
One approach involves injecting hyaluronic acid filler around the base of or behind the ear. The added volume changes the angle between the ear and the side of the head, making more of the ear visible from the front.
Some people seek this appearance because they believe it makes the face look narrower. This is an aesthetic preference, and the visual effect can vary.
The area behind the ear is called the retroauricular region. The facial nerve travels through a narrow bony canal in the skull before emerging near the base of the ear. It controls muscles involved in closing the eyes, raising the eyebrows and smiling.
Facial paralysis after filler: What did the study find?
The team at China-Japan Friendship Hospital reviewed 17 patients who underwent trans-mastoid facial nerve decompression. Sixteen were women, and the average age was approximately 34. MRI scans showed swelling in parts of the facial nerve.
During the operation, surgeons approach the nerve through the mastoid bone behind the ear and open the bony canal surrounding it. The aim is to relieve pressure on the swollen nerve.
Three months after surgery, patients showed improvements on most measures of facial movement and symmetry. Differences between the affected and unaffected sides decreased when patients raised their eyebrows and smiled. Patients also reported improvements in physical and social functioning.
One measure—the height of the eye opening at rest—did not improve significantly. The researchers had not documented full recovery at three months. Some patients experienced mild synkinesis, where an intended facial movement triggers another involuntary movement.
No surgical complications were reported in the group. All patients were followed for at least three months, with an average follow-up of approximately six and a half months.
Questions remain
The study does not establish exactly how the injections caused paralysis. The authors propose that reduced blood supply and swelling within the nerve’s bony canal may contribute to persistent injury, but this remains a proposed mechanism.
The study cannot determine how often this complication occurs or whether patients would have recovered without surgery. Its small size and lack of a comparison group mean that further research is needed to understand which patients might benefit from decompression.
What patients should know
New facial weakness after an injection behind the ear requires urgent medical assessment. Signs may include difficulty closing an eye, a drooping mouth corner, an uneven smile or difficulty raising an eyebrow.
Sudden facial weakness can also have other causes, including stroke. If it occurs with arm weakness, speech difficulty or other sudden neurological symptoms, seek emergency help immediately.
Original study
Qu S, Shen S, Li H, Wang C. Functional and Aesthetic Outcomes of Trans-Mastoid Decompression for Facial Paralysis After Retroauricular Hyaluronic Acid Injection. Aesthetic Plastic Surgery. Published online 21 October 2026.
DOI: 10.1007/s00266-026-06380-3
Disclaimer: This article is published by Aesthetics.news for general information and educational purposes only. It does not constitute medical advice, diagnosis or treatment, and should not replace a consultation with a qualified healthcare professional. Treatments and outcomes may vary from person to person. Readers should seek advice from an appropriately qualified professional before making decisions about their health or treatment. In a medical emergency, seek immediate medical assistance.