Have any surgeons seen this following a facelift? It seems to only impact the levator labii superioris muscle (Photo)

Question

If you have seen this what do you recommend in terms of treatment to regain at least some symmetry?

Semih Yildiz, MD, FEPOBRAS · Answer

From the photos, there appears to be asymmetric upper lip elevation during smiling or grimacing, with one side of the upper lip not lifting the same way as the other. A photo cannot identify the exact muscle or nerve involved, but after facelift surgery this kind of change can be related to temporary nerve irritation, swelling, scar tethering, muscle imbalance, or, less commonly, a more significant facial nerve branch injury.

The most important detail is timing. If this is early after surgery, many cases of nerve irritation improve gradually over several months, often with the most noticeable recovery in the first 3 to 6 months and sometimes continuing up to 12 months or longer. Your surgeon should examine the full facial nerve function, compare rest and animation, and decide whether observation, facial neuromuscular retraining/physical therapy, massage, or treatment of scar tightness is appropriate.

For symmetry while recovery is occurring, carefully placed Botox to the stronger side can sometimes soften the imbalance, but it must be done conservatively by someone experienced with facial animation. If the asymmetry persists beyond the expected healing period, evaluation by a facial plastic surgeon or plastic surgeon with facial nerve experience, and sometimes EMG testing, may help guide options. Sudden worsening, new weakness in other parts of the face, severe pain, or neurologic symptoms should be evaluated promptly.

John Michael Thomassen, MD · Answer

A zygomatic or buccal branch of the facial nerve may have been injured.  In the majority of cases the function returns but it may take several months.  You can use Botox to weaken the non-affected side so the asymmetry is less noticeable in the meantime.

Gianfranco Frojo, MD · Answer

This may be secondary to injury to the facial nerves that innervate those muscles. I would recommend seeing an experienced American Board of Plastic Surgery certified physician, ideally one who has also completed an endorsed aesthetic fellowship by The Aesthetic Society. You can look up if your surgeon is certified by Googling "Is your Surgeon Certified?" and going to the American Board of Plastic Surgery link.

Simona V. Pautler, MD · Answer

You don’t specify how long ago you had your facelift. Nerve injuries are very common with facelift surgery, and luckily the vast majority of them heal on their own in 6 or at times 12 weeks. Your asymmetry is most likely due to swelling, bruising or compression of one of the buccal branches of the facial nerve that innervates that lip elevator muscle. And yes, I have seen this type of injury and far worse. Time ought to improve this. In the meantime, I would exercise your lip to help wake up the muscle, or you could try a tiny, and I mean tiny, amount of Botox to the opposite side just for balance while you wait for the muscle and or nerve to heal.

Ajaya Kashyap, MD · Answer

Thank you for your query. I have not seen this following a facelift but have seen it after another facial procedure. If the surgical procedure was done less than one year back it is best to wait as it should recover. If, however it has been longer, than a single sided lip lift will help. A little Botox on the unaffected side will also help but limit the show of your teeth when smiling. Please discuss your options with your Plastic surgeon All the best

Arthur Dean Jabs, MD, PhD, FACS · Answer

Recommendations for treatment of asymmetry following facelift depend on how long ago your surgery was performed and what type of facelift was done. Certain approaches carry more risk than others. If this was done recently then waiting may be your best recourse as nerve related muscle weakness may resolve with healing. Botox may be used on the non affected side to decrease the evidence of asymmetry. If a plication technique was used it can be beneficial to reopen and remove/replace the plication sutures.
A discussion with your surgeon should provide more info since they know what procedure was done.

All the Best,

Dr. Jk

Ronald J. Edelson, MD · Answer

It could be a bruised nerve. You don’t give the time frame but it could take a year to resolve.,you can even it up with Botox in the meantime

Stephen Prendiville, MD · Answer

It is impossible to answer your question without a comparison to preoperative photos.  Pre-existing asymmetries are sometimes more obvious by patients after the fact. Selective injury to the levator labii superioris or more likely, the terminal branch of VII to that muscle, is extremely rare. The specific therapy is time.  If this is related to your surgery, it is extremely likely to resolve with time.

Connie Hiers, MD, FACS · Answer

You have some mild nerve damage, and Botox can be used on the stronger side to achieve more symmetry. Hopefully, your nerves will regain full function.

Have any surgeons seen this following a facelift? It seems to only impact the levator labii superioris muscle (Photo)

Answers (9)

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