The Cause of a Temporary Crooked Smile or Droopy Mouth after a Facelift, and How it Can Be Avoided

A woman's smile was still crooked 23 days since her face and neck lift. She can only see a mild improvement after the first couple of weeks. She wants to know what may have caused this.
Dr. Amiya Prasad, an oculofacial plastic surgeon, explains that this is caused temporarily by trauma to a nerve called the marginal mandibular nerve. This nerve happens to be superficially located at the area where the jowls are located in the part of the mandible called the mandibular notch. This nerve innervates a muscle called the depressor anguli oris muscle. This muscle, often referred to as the DAO muscle, is responsible for bringing the corners of the mouth downward as part of the complex of muscles that are responsible for smiling, specifically showing the lower teeth.
When patients want a procedure to lift the corners of the mouth, Dr. Prasad injects Botox or Dysport into the depressor anguli oris muscle to allow the outer corners of the lip to go up. This will create a balance between the depressors and elevator muscles in the mouth area.
In this woman's situation, Dr. Prasad explains that it is probably caused by some swelling resulting in the crooked smile. And as swelling gets better, the nerve function returns. Sometimes the nerve gets traumatized but it doesn't get permanently injured. The term for that is neuropraxia, and over several months, it tends to improve. Initially, it can be a little bit more dramatic but as time goes on, the function of the muscle tends to come back. In neurology, people generally wait 3-6 months before they get concerned about long-term permanent injury.
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