Can Ultherapy or Even a Traditional Facelift Result in a Healed but UNEVEN Facial Expression?

I know the story---It would not necessarily happen with a highly skilled plastic surgeon.

Doctor Answers 13

Asymmetry after facelift or ultherapy

Every face is asymmetric.  I always point out to patients their asymmetries of eye, cheeks and jawline, mouth and eyebrows before surgery so that they won't be surprised after surgery that the same underlying asymmetries are still present.

Ultherapy is certainly not a substitute for a facelift.  In fact, we are seeing that patients may have significant volume loss with some of the microwave or radio frequency based treatments.  Could that also affect the underlying nerves, which have sphingomyelin sheaths, with high fat content?  I don't know.

Nerve damage or asymmetric pull can also create asymmetries in the face but are typically minor with highly experienced plastic surgeons.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 177 reviews

Uneven facial expression

In almost 34 years of doing facelifts perfect symmetry does not exist.Facial nerve injury with facelifting is rare if the surgeon knows what he is doing.I don'tbelieve the ulthera could cause nerve injury.So the key is to go to a good surgeon. who is board certified.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 62 reviews

Facial expression is not altered by Ultherapy

Ulthera microfocused ultrasound generally does not go deep enough to affect the nerves controlling facial muscles, which would be the cause of uneven facial expression. It is rare with facelift surgery and usually temporary when it does occur. I should point out that facial expression is naturally asymmetrical to begin with so I assume your question pertains to nerve damage issues. Also, Ulthera is not truly an alternative to a facelift since it is only designed to lift facial skin, while a facelift is a 3-dimensional operation.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

Facelift asymmetry

With either procedure, asymmetry in expression as a complication is very rare.  It would be slightly higher with surgical facelifts, especially if extensive midface work is required.  A board-certified Facial Plastic Surgeon is used to working around the facial nerve and such risks are very low.

Best wishes

David Alessi, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 16 reviews

Nerve injury is a risk with facelift surgery

I am not aware of Ulthera causing nerve injury, but certainly a facelift surgery is a possibility. Facial nerve injury can affect the muscles of facial expression, but usually these are stretch injuries that should resolve in time. If the injury is no better after about 6 months, it probably will not improve. Botox has been used to treat the OTHER side in order to even out the asymmetry, in selected cases.

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 39 reviews

Uneven facial expression following procedures

are very rare... Ulthera has been known to temporarily cause some weaknesses but they always resolve.  Facelifts can result in asymmetry but the actual muscle movement  shouldn't be any different from what it was before.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Asymmetrical results

While symmetry is the goal of any procedure, yes, asymmetry can be a result. This is especially true if you have a subtle underlying asymmetry, like one cheek bone higher than the other.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
4.5 out of 5 stars 25 reviews

Uneven Expression Following Ultherapy or Facelift

It is difficult to tell from your question if you had both Ultherapy and a Facelift or are considering either procedure.  It is highly unlikely that Ultherapy will create any type of asymmetry of expression, as the results of the procedure tend to be much more subtle than that of a traditional facelift.  It is also quite unlikely to have an uneven expression following a traditional facelift if you have seen a qualified, board-certified plastic surgeon.  You don't mention how long ago you had either procedure, so there definitely can be some post surgical swelling following a facelift that will change as time goes by. I hope this helps. 

Steven L. Ringler, MD, FACS
Grand Rapids Plastic Surgeon
4.9 out of 5 stars 69 reviews

Uneven Facial Expression

As others have correctly noted, mild facial asymmetry is more the rule than the exception.  Regarding asymmetry of facial expression related to neuropraxia of a branch of the facial nerve, this is highly unusual in experienced hands, and generally temporary when it does occur. Facial nerve anatomy is very consistent, and avoidance of problems comes with experience and knowledge of the anatomy.  Injury of  a branch of the facial nerve with Ultherapy is listed as a complication, but highly improbable.  The real key in seeking out a Surgeon is to focus on a Facial Plastic Surgeon who makes facial rejuvenation the core of his/her practice, view lots of pictures, and follow your general gut sense about whether you are in the right place.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

Uneven Facial Expression

Assymetry or uneveness of facial expression can be made worse after a facelift or ultherapy, however, it would have likely been pre-existing. Surgery can lead to uneven facial expression, but this is unusual. I would recommend you speak with your physician about your concerns as each individual case can be unique.

James Chan, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 58 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.