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

 

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.

Sorry to hear about your difficulties after your surgery. This issue with your smile is do to swelling/stretching or damage to a nerve in your face, called The Facial Nerve. Specifically, a nerve called the Marginal Mandibular Nerve. This is a common nerve to get injured during a facelift. Often times, the act of pulling and stretching the tissues causes swelling in the nerve and thus, loss of function can occur. In the vast majority of situations where this happens, you will get full function as the nerve heals. The worst part is, it can be a slow process and patience is required. Hopefully you will start to see some results and improvements over the next few weeks. Dr James Bonaparte

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. 

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.

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,


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)

The fact that it has improved is a good sign

You can also try a short course of oral steroids to reduce the swelling around the nerve in order to speed the recovery

Botox on the other side will create symmetry as you heal

Bring these concerns up with your surgeon


Best regards,

Nima Shemirani

The pictures do seem to suggest quite a bit of improvement over the past couple of weeks.  I would be encouraged by this.  The suggestion of Dr. Liotta is a good one which is to have botox in the chin depressors on the right side to make the mouth look symmetric while the nerve is recovering.  Recovery can be complete or partial and yes it can take many months.

You have post operative marginal mandibular nerve palsy. This is usually from a stretch to the nerve rather than a transection. Fortunately this resolves with time in most patients (6 weeks to 6 months) Your surgeon could consider balancing Botox on the contralateral side to help even the smile as the nerve recovers.