Crooked smile

[Nini1221]

After facelift surgery four months ago, my smile has been crooked.  By reading online, I think the mandibular nerve must be damaged and will not let the muscle move my lower lip down.  Do I have a chance of it healing at all?  If so, will it come back gradually?  Has it been too long for this to heal?  

[Nini1221]

Thank you again for the info.  I guess my only other question would be if I heal, will it be gradually or one day will my old smile come back instantly?  As I said, it has been four months.  Do I back to my PS or a neurologist?  And, if I'm feeling no pain, does that mean the nerve is dead? How long should I wait before I can realize that it will not come back?

[Bhupinder Kaur, MD]

Hello,
Tensionless technique represents a critical aspect of any nerve repair in which both ends of the nerve should be freshly cut and three to four epineurial stitches are placed circumferentially.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Nini1221]

Thank you so much for the information.  I know that I was bleeding badly on that side of the face where the nerve or muscle isn't working.  There was plenty of pain in the chin area on that side for a few months and now has subsided, which is why I think maybe the nerve was cut or not going to repair.  I don't know if you can tell by that or not.  I understand what a nerve graft is, but as I read further, I think sometimes that takes a very long time to work, if at all.  Can you explain what a tension less technique is?  You cannot tell there is anything wrong until I smile or laugh, and then I feel real self conscious.  I am very saddened by this result. Also, the PS did say he had to cauterize a lot to stop all of the bleeding.  I am at 4 mos. postoperative and am waiting patiently everyday.  Do I go back to my PS or a neurologist?

[Bhupinder Kaur, MD]

Hello,
For nerves that sustain direct injury (such as from traction, cautery, etc), a typical time frame for recovery may be anywhere from several weeks to 6 months. Other than that, tensionless technique and nerve grafting may be needed.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.