Crooked smile and lines on side of face 7 weeks post op. from Traditional facelift and Dot laser, should I be concerned? (photo)

Question

I am almost 7 weeks post op. from a traditional facelift and DOT laser. I did have liposuction to the bottom of my chin. I did go with a board certified plastic surgeon. He does not seem to be concerned about this but I am having a hard time with having my confidence back. When should I start to be concerned? Is botox a good idea or will I be chasing both sides to keep them even? Thanks so much for any replies! I go back to see my Surgeon in 2 weeks.

Charles S. Lee, MD, FACS · Answer

Most likely from the neck liposuction from my experience. This usually returns to normal after several weeks to several months. Cutting it is much less common and I would be concerned if there is absolutely no improvement over 6mo. Any improvement over time indicates the nerve is still intact and will return to normal. Keep in touch with your surgeon.

Thomas A. Mustoe, MD, FACS · Answer

You have an injury to the nerve that supplies the muscles to lower lip on the right side where the lip is higher.  Usually these recover, but can take many months.  I would continue to follow with your surgeon. Botox to other side will improve symmetry.  If it fails to recover after a full year, there are some reconstructive options.   The lines at the side of the mouth probably will not go away, but the face is certainly changing so best to wait a full 6 months.  At that point if they persist, options include fat grafting, additional laser, and revision to the facelift.  It is too soon to say what the best option is. Good luck, and continue to follow up with your surgeon.

John Michael Thomassen, MD · Answer

Your marginal mandibular nerve was injured, either stretched or cut, from the laser or facelift procedure.  Usually if just stretched, it should return in side of 3 months.  Botox to the unaffected side may help with symmetry in the meantime.  The lines on the side of the face may require a revision to pull the skin slightly tighter and efface them.

Andrew Campbell, MD · Answer

You have a weakness of the muscle that pulls your lip down on one side. This almost always comes back with time. It usually takes about 6-8 weeks for a minor stretch or cautery injury, so hopefully this will improve quickly. Botox isn't a bad idea to make things symmetric. I'd recommend Botox to BOTH sides so both wear off at the same time if you would so desire. Otherwise, keep seeing your surgeon regularly.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Dallas Buchanan, MD · Answer

Thank you for your pictures and questions. It appears that you have a nerve injury. The good news is that most of these are temporary, and hopefully yours will continue to improve with time, although there is a possibility that it could be permanent. Make sure to follow closely with your surgeon and discuss your concerns with him or her.Good luck!

P. Daniel Ward, MD · Answer

you appear to have some weakness of one of the branches of the facial nerve, the marginal mandibular branch. Nerve injury after facelift is very uncommon and when it does happen, it typically always resolves on its own after a few months. I would strongly recommend considering Botox to help even out the face while you wait. Discuss these concerns with your surgeon to come up with a plan for management of this issue.

J. Charles Finn, MD · Answer

You have an injured right marginal mandibular nerve. This might recover on its own, but unfortunately there is a possibility that this is permanent. Full recovery may take months.  Botox to the other side could help restore symmetry and buy you time to see if the nerve can heal on its own. Keep working with your surgeon and try to be patient!

Karol A. Gutowski, MD, FACS · Answer

You seem to have a nerve weakness that usually gets better in a few weeks. Continue with your surgeon for now.

Crooked smile and lines on side of face 7 weeks post op. from Traditional facelift and Dot laser, should I be concerned? (photo)

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