My Smile is Crooked 23 Days Post Face and Neck Lift? (photo)

Thank you for your question and photographs. A crooked smile indicates weakness of the facial muscles and is an indication of loss of function of certain branches of the facial nerve or cranial nerve VII.

Comparing your 7 day and 23 day photographs it is apparent to me that you have had improvement  in the upper face as during a smile at 23 days the mouth is lifted whereas at 6 days  the upper muscles that controlled the mouth were not working.

At  23 days you still do have weakness of the lower lip.   The lower lip detrusor muscle which normally pulls the lower lip and corner of the mouth down is not working fully and the lip is allowed to move up and over the lower teeth.  The branch of the facial nerve that innervates this muscle is called the Marginal Mandibular Branch of the facial nerve.

Fortunately 75% of facial nerve dysfunction following facelift and neck lift recovers and returns to normal.  This return of function is usually complete by 6 weeks or about 40 days.

DC or direct current electrical stimulation of the week of muscles can help speed recovery.

it is crucial that you see your plastic surgeon, discuss your concerns and inquire about your surgeon's recommendations for management of this issue.

The situation you have is due to temporary trauma to a nerve called the marginal mandibular nerve. This nerve happens to be superficially located at the area where the jowls are located in the part of the mandible called the mandibular notch. This nerve innervates a muscle called the depressor anguli oris muscle. This muscle, we often refer to as DAO, is the muscle that is responsible for bringing the corners of the mouth downward, specifically for smiling and showing the lower teeth, and is part of a complex of muscles in the mouth area.

When patients want a procedure to lift the corners of the mouth, I inject Botox or Dysport into the depressor anguli oris muscle to allow the outer corners of the lip to go up. This will create a balance between the depressors and elevator muscles in the mouth area.

In your situation, it is most likely swelling that is responsible for your crooked smile. As swelling gets better, the nerve function will return. Sometimes the nerve gets traumatized but it doesn’t get permanently injured. The term for that is neuropraxia which tends to improve over several months. Initially, it can be a little bit more dramatic but as time goes on, the function of the muscle tends to come back. In neurology, people generally wait 3-6 months before they get concerned about long term permanent injury. I hope that was helpful, I wish you the best of luck, and thank you for your question.

The reason your smile is off is because the marginal nerve, a branch of the facial nerve has been traumatized. At 23 days, it's difficult to know if this was a partial injury (if this is the case, the function should return) or a complete injury (if this is the case, function will not return). You should ask your PS if anything unusual happened during surgery.There are nerve tests that can be done to help determine if the injury is complete or not. Consult with a neuro-otologist.

On infrequent occasion a patient can experience a somewhat uneven smile after a facelift.  In great majority of patients it resolves spontaneously.  There are different causes for uneven smiles – different nerves, different muscles, differential tissue swelling, etc.  An experienced surgeon can thoroughly assess the cause of asymmetry and make a proper diagnosis.  In this fashion a more accurate time course for recovery can be predicted.  In your particular case, your lower lip weakness can be caused by either marginal mandibular nerve injury, or lack of depressor function of the platysma.  A thorough examination can determine the cause and likely recovery.

Hello, and sorry to hear about the issue you are experiencing following your facelift. In general, the side effects of a facelift may include:

1) Swelling
2) Firmness
3) Bleeding
4) Numbness
5) Bruising
6) Nerve injury that is temporary but sometimes permanent

A crooked smile can be caused by temporary nerve damage, which will usually resolve itself within 6 months to a year following surgery. It may take even longer for a complete recovery, but it really depends on the patient and the extent of their surgery. The improvement is generally slow. Since you are only 23 days post-op, improvement can take some time. It is too soon to tell whether or not any nerve damage you are experiencing is permanent, but this will rarely be the case. I would recommend speaking with your surgeon regarding the issues you are experiencing. He/she may be able to provide some additional insight. Thank you, and best of luck with the remainder of your recovery!

I agree that your loss of full muscle action in your left lower lip does appear to be improving and most likely will continue to improve back to normal. This does occur from some trauma to the branches of the facial motor nerve that exist near your lateral chin during surgery. This was probably some blunt trauma from a liposuction cannula or retractor and if so, the nerve is only temporarily hurt. Until full function is restored, you can consider having someone carefully Botox the musculature on your right side.

Best of luck. 

Temporary weakness of the marginal mandibular nerve rarely occurs after facelift. Most of the time it is self-limited and will improve although it may take months for normal function to return completely.

Likely swelling around the nerve, if you think of the nerve like a wet matchstick it will make sense. While wet (injured) it wont work if you wait for it to dry (heal) it will. The fact that you have some movement suggests it is intact

Dear terrora,

1. I agree with the other surgeons, it could also be that the muscle that goes to your lip is bruised as well (depending on the technique)
2. The fact that it has improved is a good sign
3. You can also try a short course of oral steroids to reduce the swelling around the nerve in order to speed the recovery
4. Botox on the other side will create symmetry as you heal
5. Bring these concerns up with your surgeon

Best regards,

Nima Shemirani

You have a facial nerve complication of the marginal mandibular nerve. Best to address with your surgeon ASAP. This could be temporary as a paresis or a true injury//