I am 46. My left side has dropped, festoon on top of the left cheek and the left corner of the mouth has dropped (Photo)

Thank you for the question. Your brief history and photos are helpful but they cannot replace a full in depth in person history and facial exam. Having said that, if I have understood your note correctly it suggests that this has been a weakness/asymmetry that has slowly worsened over 3 years. If this is the case the diagnosis of Bell's palsy is questionable. Your facial exam which can only be very limited from the photos provided shows you have a degree of reduced movement of the smile on your left side and possibly flaccidity (reduced facial tone) on your left midface area causing your cheek and your corner of the mouth to droop slightly and reduce the wrinkles around your left eye when you smile. The combination of reduced smile and reduced facial tone in my experience would not be classical of a patient who has had Bell's Palsy 3 years previously unless the patient had recently been treated aggressively with botox to the affected side. 
I would seek a further opinion from a University Institution Otolaryngology Department with an interest in facial paralysis diagnosis and treatment. I hope this helps. 

You do have evidence of a partial facial nerve paralysis giving weakness to the muscles on one side of your face and causing it to sag more than the other side.  I agree that the most likely  diagnosis is Bell's Palsy which is believed to be due to a virus affecting the facial nerve.  Unfortunately recovery is not always complete, and after one year you cannot expect any further improvement.  At this point the best solution is a lower facelift with attention to the midface through a deep plane subSMAS approach, as well as a lower lid tightening.  Both sides should be approached to optimize symmetry. I have done a deep plane facelift on a few patients with your problem significant improvement.  It is important I believe to choose an experienced surgeon who does an extensive subSMAS release that effectively improves the midface and also addresses the malar festoon.

It does appear that you have Bell’s palsy. At 3 years out, the chances of spontaneous recovery are slim. Additionally, the longer that the muscles of your face do not have any nerve input or activity, the more likely they will be to deteriorate and not work properly ever again. I would suggest you meet with a different plastic surgeon who specializes in facial surgery related to Bell’s palsy. There are options for improvement, but not likely options at this point to re-innervate the muscles that aren’t working. 

A face lift can improve your symmetry post Bell's Palsy while your face is at rest but when you smile or animate the asymmetry of muscle function is still going to be visible.  Restoration of muscle function after three years requires either muscle transfer or a neurotized free muscle sling. Please consult with a Board Certified Plastic Surgeon who is experienced with these techniques.  In my opinion, I would wait to do the face lift until you have the procedure to restore muscle function performed, unless your surgeon feels it can be accomplished simultaneously.  I hope this information helps you.  

My chairman, Dr.Leonard Ruvin pioneered dynamic  facial reanimation for patients with with Bell’s palsy. His partner, and my other chairman, Dr.Roger Simpson (located in Long Island New York) continues in performing this ground braking work. They use the chewing muscles in your face (which still function in patients with Bell’s palsy) to reanimate the mouth/smile. Dr.Simpson has lectured nationally and internationally on this subject. I hope you find this information useful. 

Thanks for the question. To gain symmetry is sometimes difficult but you would improve the left side by performing a cheek lift and lower lid blepharoplasty with a skin and tear trough correction simultaneously. I notice that brow position could be raised on both sides. Hope this helps and you should now go back to a board certified plastic surgeon and see if he or she is willing to proceed along this direction. 

I'm sorry to hear about your condition.  This is a tough diagnosis and sometimes leaves residual problems for patients.  Without an exam, it will not be possible to fully evaluate you and give you recommendations.