Crooked smile. Will this go away with time? (Photo)

Question

I still have a crooked smile 10 weeks Post op. And slight movement left side of nose but can’t blow my nose that side. Will this go away with time as my surgeon says do nothing. No facial exercises. Massage. Pulse or tens machine. Electric stimulation at all my left jaw is very numb

John Michael Thomassen, MD · Answer

The zygomatic branch of the facial nerve may have suffered some damage.  Usually it is stretch damage or neuropraxia which means function should return somewhere inside of 3 months.  However at 2 1/2 months you would expect to see some improvement as there are multiple branches that can compensate for this.  Even if the nerve is cut there is high likelyhood that due to multiple branches of the nerve, the muscle weakness is self limited.  Follow up closely with your plastic surgeon and a neurologist.

Charles Nduka, MD · Answer

At 10 weeks, it is uncommon for nerves to have no significant improvements. You might be experiencing a facial nerve damage. It will be difficult to say whether your nerve will recover fully or not. Schedule an appointment with a neurologist for nerve tests and he/she will be the one to give you a recovery and rehabilitation potential depending on the severity of the nerve damage.

R. Scott Yarish, MD · Answer

This is truly abnormal and unusual to show no improvement in nerve function after 10 weeks.  That doesn't mean function won't return, however.  I would see a neurologist who can define the extent of the injury (although only guess at recovery).  They typically give exercises and physical therapy as a means of stimulating recurrent function.  This is a distressing situation but fortunately is likely to resolve to a great extent, if not complete recovery.

Jonathan Zelken, MD · Answer

Hello,
I am sorry that you have asymmetry with your smile. I have high hopes that this should improve at least somewhat without intervention.
I want to offer more thoughtful advice, but really think you need to seek the opinion of a different, board-certified plastic surgeon. I really am hesitant to cross the line, and I may be wrong, but I am a little unsatisfied with the recommendation you've received to do nothing.
Please do keep us posted.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  I am sorry to hear about your change in facial movement after your facelift.  You might want to discuss, with your facelift surgeon, a referral to a neurologist for nerve stimulation and testing to determine the level of facial nerve injury along with and ENT surgeon referral that's experienced in facial nerve repair.  "If" a nerve repair is possible, time is of the essence. Your photos appear to show weakness on the left side of both the upper and lower lips.  The lower lip weakness is caused by an injury to a single branch of the facial nerve called the "marginal mandibular" nerve that innervates the lower lip depressor muscle.  This is the only innervation to the muscle that pulls down the lower lip.   If the upper lip can't be raised with smiling or a grimace, this would indicate injury to the "buccal" and possibly "zygomatic" branches of the facial nerve that typically having significant cross innervation to the lip elevator muscles.  Existence of injury to both areas might indicate an injury to the "main" branch of the facial nerve which could conceivably be repaired.   In my experience facial nerve injury is exceedingly rare in the hands of an experienced facelift surgeon but is a possible complication.  The risk increases with the more invasive type facelifts versus the minimally, invasive SMAS facelift described below.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.Hope this helps.

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