Crooked Mouth and Numb Lip 13 Months After Facelift - Is Recovery Still Possible?

It sounds like you have a nerve injury. I am sorry this occurred with your midface lift. The face has five nerves that gives it motion. The branch to your upper lip cheek probably isn't ball. It has been 13 months and recovery may be near completion. Even if the nerve for continuing to grow the muscles over time will atrophy and not be receptive to healing. There is a definitive window of opportunity for her healing.  I would seek a second opinion from a board certified plastic surgeon with specialized training in facial reanimation.  Best wishes.

Dr. ES

Facelift of any variety may create short-lived facial nerve malfunction due to pressure were swelling. This should have been long since resolve at 13 months. It would probably be good idea to get another opinion.

When you have a nerve injury, it can be due to traction (pulling) on the nerve or cutting the nerve.  If the injury is a result of traction, you should see improvement within a year - subtle improvement can occur even longer.  Given that it's 13 months and still have significant symptoms, I would recommend getting a second opinion.

I would discuss your issues with the surgeon who performed the operation. He would want to know and be involved. Best of luck

Dear Annie,

thank you for your question.  It sounds like you have a traction or transection injury on your infra-orbital nerve.  This is the nerve that emminates from under the eyeball socket through the cheek and then provides sensation to the side of you nose, the front part of the cheek and the upper lip.  This nerve can be pulled on with the lift, or can be cut during the dissection   It would be unlikely that the nerve was cut as you are not stating you have numbness to your nose or cheek, mainly the lip.  Therefore, I have to assume that is is a traction injury, or pulling on the nerve.  This usually recovers by a years time, but improvements have been seen up until 2 years time.  If it continues to slowly improve, then you and your plastic surgeon may elect to continue to watch it.  If it is stagnant, then you may opt for an exploration or not.  As far as the facial movement, this is a completely separate issue.  This is related to muscle disfunction, or a different nerve (buccal branch of the facial nerve).  Again, if this is improving, you may elect to continue to watch it.  massaging the area along the cheek may also improve things. 

Best wishes,

Pablo Prichard, MD

The likely cause of your symptoms is traction or transection of the infraorbital nerve.  There also is muscle weakness probably related to motor nerve traction or transection.  Since it has been 13 months since your surgery, significant improvement is unlikely.  Please obtain a second opinion from a Board Certified Plastic Surgeon or Facial Plastic Surgeon.  An office examination will provide important information.  Botox can be used to weaken the stronger side of muscle action which would make your smile more symmetrical.  The injections would have to be repeated every 3-6 months unless muscle activity returns on the weaker side.

You probably have an injury to the infraorbital nerve.  This may be due to injury at the time of surgery but usually this improves over a few months after surgery.  At  13 months you may need exploration of the area to see if a permanent suture is pinching the nerve.   This may also free up the asymmetry.  Donald R. Nunn MD  Atlanta Plastic Surgeon.

Hi.

Your history suggests two different nerves are involved.  You may continue to improve for another six months, but I would definitely get a couple of different opinions. You may need some tests, and also nerve exploration may be indicated.

As has been explained by the other doctors, you have an Infra Orbital nerve injury from the procedure and the chances are that complete recovery of numbness after 13 months is unlikely although you may get some additional improvement.  The fact that your mouth draws to the opposite side when you smile indicates that you also may have an injury to a branch of the Facial nerve and this could be more problematic.  Motor nerves like the Facial nerve when injured will either recover within a year or they are permanently affected.  At this point you shoul get another opinion and go through some testing to determine the extent of injury to the nerves.

This is an unusual complication but results from damage to the infra orbital nerve.  This is the nerve somewhat at risk in a midface lift.   The symptoms you discuss could all be more or less traced to this nerve injury.  Th IO nerve can be stretched or cut during a Mid Facelift.   You should experience improvement but the longer the problem, the less likely a full correction will occur.   Neurological studies show  some nerve improvement for 5 years but by 13 months it is worrisome.   A good % of improvement that will ever occur has already occurred  by 13 months.   Your motor symptoms are not caused by the ION  damage but rather to direct damage to the muscles that lift and act upon the upper lip and  corner of mouth.  This is all a little  rare and strange.  I suggest you seek consultation by several FACS-ABPS surgeons in your area.  My Best.   Dr C