I Am 3 Weeks Post-op from a Facelift and Now Have a Crooked Smile. Permanent?

The corner of the mouth/lower lip is pulled down by the depressor anguli oris muscle, which is innervated by the marginal mandibular nerve. This nerve is one of the branches most commonly weakened after a facelift. Usually movement will recover in 6 to 12 weeks, although complete recovery may take longer. The incidence of permanent injury is fortunately low. Discuss your concerns with your surgeon. Exercising (trying to use the affected muscle) may improve recovery.

Thanks for your question!
While it's hard to tell definitively without photos or an in person exam, my guess is you have a temporary weakness of some of the smile muscles, the depressor muscles in particular which are innervated by the marginal mandibular nerve. This can happen occassionally during a facelift and will amost always return over time. The fact that you are already having some movement in the area is also a reassuring sign. I would definitely let your surgeon know as well so they can continue to monitor for complete resolution.
Hope this helps and best of luck! Kyle Kimura, MD

In answer to your question about asymmetrical smiling after facelift surgery there are a number of aspects that are important with this. 
With normal healing, principally swelling, often there can be subtle effects on smiling that resolve as the swelling reduces. Although most patients have normal smiling after 1-2 weeks sometimes as long as 6weeks. The very final result from facelift surgery can be as long as 6-12months however changes in smiling do not usually take this long. 
Rarely after facelift surgery there can be stretching of a motor nerve this can result in an asymmetrical smile. However this does improve as the nerve recovers, however it can take 3-6months to fully recovery. For some patients botox treatment can help improve facial asymmetry while the nerve is recovery. 
It would be a good principal to see the surgeon who completed the surgery for you, to reassess your symptoms and signs and discuss with you the best possible management. 

 It can be disturbing to a patient to have less than full function of the facial muscles after a facelift, however permanent nerve damage is very rare with facelifts. You will have to be patient, up to 12 months, to see whether you return to full function. The fact that you have some twitching of the muscles around the weakened muscle is encouraging and you should be following up closely with your plastic surgeon so that this can be monitor.

Pictures would help, but based on your description, a crooked smile usually means injury, partial or complete facial nerve damage which may or may not return completely and can take up to two years post surgery to recover. The numbness takes a variable time to recover but eventually most people have return to normal sensation. Botox can sometimes help with the asymmetry of your smile. A filler or fat injection may help with the indentation. Your plastic surgeon if well trained would be the best one to figure this out. If you are not confident in his opinion, there is potential benefit in seeking a second opinion.

Based on your description it appears that you have weakness of one of the branches of your facial nerve.  This typically resolves with time, but can take up to 6 months.  Botox (to the normal side) can often help reduce asymmetry

You should see a Board Certified Plastic Surgeon, and have your face evaluated.  You are still fresh from a surgery and inflammation is present so this all may return to normal, but you do need to be evaluated.    See a Board Certified Plastic Surgeon who is in your area and one who does a lot of facelift procedures.

Although this could be nothing to worry about, I would suggest making a follow up appointment with your plastic surgeon to discuss as soon as possible.
 

Dear Popeye13,

Your facial nerve most likely has been bumped, bruised or stretched. Fortunately, the weakness is usually temporary and lasts weeks to several months. In rare occasions the weakness may last up to a year. This can be a very stressful time while you are waiting for the nerve to come back. Please try to be patient and know that permanent damage is very rare. The fact that you are feeling twitches is a good sign. Good luck.

Although it is quite rare to have weakness of the lips after a face lift, it occasionally does occur.  It is most likely from minor injury to the marginal mandibular branch of the facial nerve ( the nerve that controls facial expression on the face).  This can be caused by stretch injury to the nerve or using electrical cautery to stop bleeding in the immediate vicinity of the nerve.  In almost all cases the function will return with time. Unfortunately, sometimes this can take months. Make sure you let your surgeon know what is going on and I'm sure he/she will reassure you that in all likely hood you will be fine.  Good luck.