Why is my smile not the same? (Photo)

Question

I got chin Lipo, buccal fat removal and a chin implant. I’m almost 2 months post op and my smile and bottom lip are not functioning the same. How can I differentiate complete transection from temporary injury to the monjurul mandibular?

Jacob Tower, MD · Answer

Hello, hope you are well. The picture that you posted shows a relatively subtle asymmetry of the lower lip with less strength on the right side (left side of the photo). Assuming it's new, and a result from surgery, this may be from neuropraxia of either the marginal or cervical branch of the facial nerve. (Some people naturally have asymmetries like this from birth--called CULLP). It appears that you have tone of the depressor muscles, but not symmetric strength, which would suggest a temporary injury and not a complete transection which would result in flaccid paralysis of the muscle group. It can happen from liposuction around the jawline, and less likely from a chin implant or buccal fat removal. My advice is to be patiently optimistic--it sometimes takes many months for complete return of function. Even after the nerve has recovered, the muscle needs to regain its strength. Be sure to ask your surgeon for advice and guidance as well.
Best,Dr. Tower

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Mats Hagstrom, MD (license on probation) · Answer

A complete transaction of the nerve would give complete paralysis to the muscles innervated on that side.
It appears you have partial function, so this most likely represents neurapraxia or weakening of the nerve.
Neurapraxia often improves on its own given enough time.
Best,
Mats Hagstrom, MD

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