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

 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.