Neck lift revision - left side of mouth doesn't work and long indentation. How can this be fixed? (Photos)

Question

I am 63 I had my first deep plane face and neck lift Jan 2024. I had a revision in Feb 2025. Since the second one, I look horrible. The left side of my mouth doesn't work and there is this long indentation that goes upwards from the left side of my mouth. I don't know what to do, and I am completely distraught. I look so ridiculous. Please help me

Elie Ramly, MD · Answer

Thank you for your question and for sharing your photos. I’m sorry you are dealing with this. Your photographs do show asymmetry around the left lower face and mouth, as well as the contour depression you mentioned. That being said, photographs alone cannot reliably determine what is causing either finding.
Because you specifically mentioned that the left side of your mouth “doesn’t work” following revision deep plane facelift and neck lift surgery, the first priority is a careful facial nerve examination. Nerve injury, muscle dysfunction, scar tethering, or mechanical restriction of the tissues are potential explanations. The timing, whether there has been any gradual improvement, and physical examination of your face at rest and in motion are important in distinguishing these possibilities.
The indentation also needs to be evaluated in detail. After primary and revision deep plane facelift surgery, contour irregularities can potentially result from scar tissue or adhesions causing tethering, volume deficiency, or altered positioning of the facial tissues. Differences in the extent of deep plane dissection and ligament release as well as the vectoring and inset of the lifted tissues could also be contributing factors.
Treatment depends entirely on the underlying anatomical problem. Depending on the examination and your prior operative details, options could involve evaluation by a facial nerve specialist if a nerve-related issue is indeed identified on exam, as well as surgical or nonsurgical options to address your aesthetic and functional concerns. A formal revision surgery is a potential option, but it would be wise to attempt less invasive solutions first if deemed appropriate on exam. Given that you have already undergone both a deep plane facelift/neck lift and a subsequent revision within a relatively short period of time, I would avoid rushing into another operation until your anatomy and facial nerve function have been carefully assessed. Obtaining the operative reports from both surgeries would also be extremely helpful.
A consultation with a plastic surgeon experienced in complex facelift and neck lift surgery and in revision facelift and revision neck lift surgery, and a formal facial nerve evaluation if weakness is confirmed, would be an appropriate next step. The key is to determine whether you are dealing primarily with nerve dysfunction, mechanical/dynamic restriction, scar tethering/soft-tissue distortion, volume loss, or a combination of these issues before deciding how to correct it.

Neck lift revision - left side of mouth doesn't work and long indentation. How can this be fixed? (Photos)

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