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

I am 3 weeks post-op from a facelift and now have a crooked smile. How can I tell if this is permanent? My right bottom lip won't move down, so when I smile and I look like "Popeye." When I try to make the right bottom lip go down, there are little muscles under my lip that jump around like they are trying to work.

Doctor Answers 22

Weakness in smile after facelift

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Although it is very concerning for any patient to see some weakness in muscle movement after a facelift, permanent nerve injury is not very common. It is more common to see weakness due to stretching or swelling around the nerve branches which move the muscles of the face. Something to note would be if the smile has changed at all over the 3 week period since the surgery. Although it may take a number of months for nerve weakness to resolve, you should slowly start to see increasing muscle movement with time. You do describe some muscle twitching which is definitely a better sign than no muscle movement at all. I would definitely discuss your concerns with the surgeon so that your progress can be monitored.

Inland Empire Facial Plastic Surgeon

Crooked smile after facelift

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you describe a weakness of the right marginal mandibular nerve. if the lip flickers then i expect continued improvement. even if the flicker is in different muscles, at 3 weeks weakness is not necessarily a sign of a nerve being cut. much more likely it is a neuropraxia (injury that will heal). unfortunately, permnanent injuries do occur so continue to see your surgeon often to asess your progress. If there is no movement at 3 months consider exploration and repair of nerve, this needs to be done by a surgeon with experience in facial nerve injuries and nerve grafting. good luck

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

Assymmetries after facelift likely will resolve with time

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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.

Steven Goldman, MD
Cleveland Plastic Surgeon
5.0 out of 5 stars 168 reviews

Facelift - Crooked Smile at 3 Weeks

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Fortunately, the majority of these situations resolve spontaneously - it may take a few weeks or even a few months this deficit to get better, but most likely it will.  There is a small percentage of patients in whom these problems are permanent, but while it may be possible to assess that (in theory an MRI could show a complete division of a nerve, for example) it is more likely not to show anything.  And the fact that you have some twitching is a good sign.  You should discuss this with your PS and if there is even the slightest possibility of a complete division of a larger nerve, consider having it assessed non-invasively (ie an MRI) since early repair is beneficial.  That being said it is important to emphasize again that the overwhelming majority of these issues resolve on their own, without intervention of any kind.

I hope that this helps, and good luck,

Dr. E

Facelift Crooked smile Usually will improve over weeks and months

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Facelift Crooked smile Usually will improve over weeks and months. This can be due to swelling and sometimes, more rarely, facial nerve stimulation to injury. The fact that you can have some twitching is a good sign and likely that you will have a full recovery. I would wait at least 6 months before considering doing anything or being concerned.

Thanks for reading, Dr Young

Philip Young, MD
Bellevue Facial Plastic Surgeon

Lip weakness is almost always temporary after facelifting surgery

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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.

Adam D. Stein, MD
Raleigh-Durham Facial Plastic Surgeon
4.7 out of 5 stars 56 reviews

Crooked smile post facelift

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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.

3 Weeks Post-op from a Facelift and Now Have a Crooked Smile

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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

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Crooked Smile After Facelift

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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.

Douglas L. Gervais, MD
Minneapolis Plastic Surgeon
4.8 out of 5 stars 178 reviews

Lower Lip Weakness Following Facelift

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While weakness of the lower lip can be devastating both functionally and aesthetically, this does not necessarily mean it is permanent.  Often times, this is caused by stretching of the marginal mandibular branch of the facial nerve and recovers fully.  Sometimes, permanent weakness can result which requires attention of a facial plastic surgeon who specializes in treatment of facial paralysis.   In your case, it it too early to say whether this is permanent or not.  I would recommend that you discuss and have close follow up with your plastic surgeon.  Be patient, as it may take several months to a year to completely resolve.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 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.