Lopsided smile after Ultherapy. Is this permanent? What should I do? (Photo)

Question

3 weeks ago I had what I thought was an Ultherapy treatment on my lower face. The procedure was insanely painful and I was swollen for nearly two weeks afterwards (couldn't lay my face on my pillow for nearly 10 days). Since the treatment I have not been able to move my lower left lip and now have a lopsided smile. The practitioner I saw was not a doctor AND i found out this week that he was using a counterfeit machine! His office has since closed. Is this permanent? What should I do?

Raffy Karamanoukian, MD, FACS · Answer

I would suggest you massage the area, do facial exercises, and speak to your surgeon about the results after Ultherapy. Best, DR. Karamanoukian Los Angeles

Kimberly Butterwick, MD · Answer

I am sorry to hear you had such a bad experience. It is unfortunately true that unlicensed, unscrupulous practitioners and counterfeit machines are out there and can cause terrible results. It is essential to research your doctor beforehand to make sure that they are legitimate and have the required experience and credentials to perform whatever treatment you are interested in. In your case, it sounds as if you likely have nerve damage to the marginal mandibular nerve. This may very likely resolve on its own, but I would pay a visit to your doctor or a nerve specialist for an evaluation.

Michael A. Zadeh, MD, FACS · Answer

This is the result of poor technique along with the use of a knock-off machine in which the safety has not been established. It's nerve injury/irritation. Most of the time it gets better on its own, but it may take months. I recommend having a physician experienced in Ultherapy and its complications evaluate you. Best wishes.

David Boudreault, MD, FACS · Answer

Hi Rocketontheroof,Thank you for your question and highlighting the importance of seeking out a plastic surgeon to help you decide on treatments.  As a group, we hold ourselves to the highest standard and will help you with your aesthetic goals.  We are also held accountable with our medical license and our specialty boards.  It appears that your treatment, whatever it may have been, has caused some nerve damage.  If this was a type of Ultherapy, it is unlikely to be a nerve transaction or permanent.  Nerves that are partially damaged can grow back and normal function returned.  Depending on where the nerve was injured, it can take several months to restore normal function.  We estimate that nerves grow about 1 inch per month (1mm/day).  It appears that your injury is fairly close to the affected muscles and should resolve in a few months.  I would recommend you reach out to a plastic surgeon to help you through this process.You can do facial exercises to augment surrounding muscles, but the real answer is time.I'm so sorry that you are having this complication, but I'm sure this will eventually be a distant memory and a valuable lesson.For others who are interested in Ultherapy, and would like to know where to find a list of actual Ultherapy providers, the Ultherapy website contains a directory of medical practices in your area.  I have attached a link to this answer. All my best, Dr. B

Steven Yarinsky, MD, FACS · Answer

One of the reasons Ultherapy result satisfaction is only 65% on RealSelf, is that there are counterfeit machines out there and the results with a real Ultherapy machine are dependent on the training and experience of the Ultherapy technician.  Ultherapy is a tool for tightening the skin of your face by encouraging the growth of new tighter collage.  If Ultherapy is used or applied in the wrong place, it can cause bruising swelling and injury to the nerves to the muscles of facial expression.  This can cause facial asymmetry and paralysis or weakness of the muscles.  Thankfully this condition, as bad as it may be to tolerate, usually self corrects in 6 months to a year.  The best way to avoid this is to have your treatment done by an expert with advanced training in avoiding injuries.  Our office Ultherapy technician has received advance training at the Phoenix headquarters of Ulthera for your safety and is the only technician in the Albany area with this knowledge set!  Knowledge and proper appropriate treatment is an equation for Ultherapy Success, and our patients are very happy with the results.As an aside, let's be thankful that your practitioner closed his office so he does not cause damage to other peoples' faces!

Matthew Elias, DO, FAAD · Answer

Thank you for your question.  This is most likely nerve damage to the marginal mandibular nerve which is a "no fly zone" with Ultherapy and you should not have energy delivered over the area.  Poor technique combined with a counterfeit machine - unfortunately has lead to these complications for you.  However, the nerve damage is likely to resolve within a few weeks and there should not be any long term consequences.  Regards, Dr. Matt Elias

Hratch Karamanoukian, MD, FACS · Answer

Thank you for your question.The Ultherpy procedure never is and should never be "insanely painful" as you describe.Once such pain is experienced, the experienced Ultherapy provider should have reduced the energy settings. I hope this resolves. It typically does based on what I have read on RealSelf.I have done Ultherapy since 2010 and have never seen this problem because I am forever careful treating around the corners of the mouth.Read my Ultherapy ebook on the link below.BestDr. Karamanoukian

Edwin Ishoo, MD · Answer

It is generally very easy to confirm online if your provider is a licensed physician before submitting to treatment. You may have neuropraxia or nerve injury and it will likely recover spontaneously but I would strongly suggest you consult with your doctor or a neurologist if the weakness persists.

Lopsided smile after Ultherapy. Is this permanent? What should I do? (Photo)

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