Hypertension from Glossopharyngeal Nerve Injury After Aesthetic Thread Lift

Overview

A 52-year-old woman developed glossopharyngeal nerve injury with subsequent blood pressure fluctuations, including initial hypotension and later sustained hypertension, following a thread lift procedure. Surgical removal of threads and supportive care led to gradual symptom resolution and full sensory recovery within four months.

Background

The glossopharyngeal nerve (cranial nerve IX) has critical motor, sensory, and parasympathetic functions, including a key role in the baroreflex mechanism regulating blood pressure. Thread lift procedures, used for facial and submental sagging correction, involve placement of threads superficially under the skin but carry risks of nerve injury if anatomical landmarks are not carefully respected. Glossopharyngeal nerve injury is rare but has been reported in other surgical contexts such as tonsillectomy and carotid endarterectomy. This case is the first reported instance of glossopharyngeal nerve damage and resultant hypertension following an aesthetic thread lift.

Data Highlights

Key Findings

• Glossopharyngeal nerve injury occurred due to thread placement near the mandible during a left-sided thread lift.
• Initial symptoms included sharp throat and tongue root pain radiating to the left palatine tonsil, hypotension, and bradycardia.
• Neurological exam revealed sensory deficits, ageusia, xerostomia, and edema consistent with glossopharyngeal nerve damage.
• Blood pressure changes demonstrated a biphasic pattern: initial hypotension/bradycardia from nerve compression-induced baroreflex activation, followed by sustained hypertension due to baroreflex failure.
• Surgical removal of threads and supportive care led to gradual symptom resolution and full recovery within four months.
• This is the first documented case linking glossopharyngeal nerve injury and hypertension to an aesthetic thread lift procedure.

Clinical Implications

Clinicians performing thread lift procedures must have detailed anatomical knowledge to avoid nerve injury, particularly near the mandible and parapharyngeal space where the glossopharyngeal nerve courses. Recognition of glossopharyngeal nerve injury symptoms—including throat pain, taste disturbances, and blood pressure fluctuations—is critical for timely diagnosis and management. Early referral for neurological evaluation and surgical intervention can prevent prolonged morbidity.

Conclusion

This case underscores the potential for glossopharyngeal nerve injury during aesthetic thread lifts, resulting in complex cardiovascular manifestations including hypertension. Awareness and careful procedural technique are essential to prevent such complications and ensure patient safety.

References

1. Glossopharyngeal nerve anatomy and baroreflex function -- Clinical Neuroanatomy Sources
2. Reported nerve injuries in aesthetic procedures -- Case Series and Reviews
3. Hypertension following glossopharyngeal nerve injury in tonsillectomy -- Prior Case Reports