In this case series, we describe transient postoperative facial nerve palsy in patients after awake craniotomy using selective scalp nerve blocks. In a 1-year period, 7 of the 42 patients receiving scalp nerve blocks at our institutions developed this complication. This is significant because there is only 1 previously reported case of postoperative facial nerve palsy related to scalp nerve blocks. The exact cause of transient postoperative facial nerve palsy after auriculotemporal nerve block is unknown and likely multifactorial. This technique may need to be refined to avoid such complications.