I Am 3 Weeks Post-op from a Facelift and Now Have a Crooked Smile. Permanent?

I am 3 weeks post-op from a facelift and now have a crooked smile. How can I tell if this is permanent? My right bottom lip won't move down, so when I smile and I look like "Popeye." When I try to make the right bottom lip go down, there are little muscles under my lip that jump around like they are trying to work.

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22 Doctor Answers | Asked by popeye13 in Pennsylvania

Doctor Answers (22)
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Weakness in smile after facelift

Although it is very concerning for any patient to see some weakness in muscle movement after a facelift, permanent nerve injury is not very common. It is more common to see weakness due to stretching or swelling around the nerve branches which move the muscles of the face. Something to note would be if the smile has changed at all over the 3 week period since the surgery. Although it may take a number of months for nerve weakness to resolve, you should slowly start to see increasing muscle... more

Gregory J. Vipond, MD

4 reviews

Pasadena Facial Plastic Surgeon

Crooked smile after facelift

You describe a weakness of the right marginal mandibular nerve. if the lip flickers then i expect continued improvement. even if the flicker is in different muscles, at 3 weeks weakness is not necessarily a sign of a nerve being cut. much more likely it is a neuropraxia (injury that will heal). unfortunately, permnanent injuries do occur so continue to see your surgeon often to asess your progress. If there is no movement at 3 months consider exploration and repair of nerve, this needs to be... more

Assymmetries after facelift likely will resolve with time

The corner of the mouth/lower lip is pulled down by the depressor anguli oris muscle, which is innervated by the marginal mandibular nerve. This nerve is one of the branches most commonly weakened after a facelift. Usually movement will recover in 6 to 12 weeks, although complete recovery may take longer. The incidence of permanent injury is fortunately low. Discuss your concerns with your surgeon. Exercising (trying to use the affected muscle) may improve recovery.

Facelift - Crooked Smile at 3 Weeks

Fortunately, the majority of these situations resolve spontaneously - it may take a few weeks or even a few months this deficit to get better, but most likely it will. There is a small percentage of patients in whom these problems are permanent, but while it may be possible to assess that (in theory an MRI could show a complete division of a nerve, for example) it is more likely not to show anything. And the fact that you have some twitching is a good sign. You should... more

Facelift Crooked smile Usually will improve over weeks and months

Facelift Crooked smile Usually will improve over weeks and months. This can be due to swelling and sometimes, more rarely, facial nerve stimulation to injury. The fact that you can have some twitching is a good sign and likely that you will have a full recovery. I would wait at least 6 months before considering doing anything or being concerned. Thanks for reading, Dr Young see video

Philip Young, MD

6 reviews

Bellevue Facial Plastic Surgeon

Lip weakness is almost always temporary after facelifting surgery

Although it is quite rare to have weakness of the lips after a face lift, it occasionally does occur. It is most likely from minor injury to the marginal mandibular branch of the facial nerve ( the nerve that controls facial expression on the face). This can be caused by stretch injury to the nerve or using electrical cautery to stop bleeding in the immediate vicinity of the nerve. In almost all cases the function will return with time. Unfortunately, sometimes this can... more

Adam D. Stein, MD

8 reviews

Raleigh-Durham Facial Plastic Surgeon

www.facialdoc.com

Facelift and muscle movement

As most have already stated a face lift it a very technical procedure whereby the skin, muscles and underlying foundation of the face are tightened, shaped and recontoured. There are many small and larger nerves in the face which may become bruised during this procedure. Rarely there is permanent injury to these nerves. At three weeks it is far to early to make any conclusions concerning your smile it takes up to three months for all of the swelling and bruising to resolve and for healing to... more

Too Early to Worry, Smile will Return

The key to giving you some piece of mind is how early you still are after your operation. As others have alluded to this type of mild asymmetry is one of those things that can happen. Your surgeon negotiates through your tissues and its his or her job to know where these nerves become more superficial. I would give you a 98% chance of recover within 6 more weeks. Try not to stress to much, be patient.

3 Weeks Post-op from a Facelift and Now Have a Crooked Smile

Based on your description it appears that you have weakness of one of the branches of your facial nerve. This typically resolves with time, but can take up to 6 months. Botox (to the normal side) can often help reduce asymmetry

Sam Naficy, MD

80 reviews

Seattle Facial Plastic Surgeon

www.seattleface.com

Crooked Smile After Facelift

Dear Popeye13, Your facial nerve most likely has been bumped, bruised or stretched. Fortunately, the weakness is usually temporary and lasts weeks to several months. In rare occasions the weakness may last up to a year. This can be a very stressful time while you are waiting for the nerve to come back. Please try to be patient and know that permanent damage is very rare. The fact that you are feeling twitches is a good sign. Good luck.