How Can I Fix The Facial Asymmetry From Bell’s Palsy?

Q: Dr. Eppley, I recently had a facelift and lip lift for overall skin laxity in aging, but I also asked my surgeon to try to correct some asymmetry I’ve experienced as a result of having Bell’s Palsy. Unfortunately, I was disappointed in the results. In some ways, it’s even worse now. Is there anything you can do in a case like mine? I don’t have faith that he can fix it, and he’s not even sure he can. Two photos attached. Thank you.

A: While you did not say what specific asymmetric facial features you see as the most bothersome nor which side of your face you prefer, I will have to make those two assumptions based on what I see in the two static non-smiling pictures you have sent. I see nose and lip asymmetries with the left nostril/nasolabial fold contracted upwards as well as the left mouth corner tilted higher than that of the right.

These are two central facial asymmetry features that could never be improved by a facelift and, as you have pointed out, actually are a bit more apparent postop which is not surprising. Facelifts are great for many sagging lateral facial tissues but can not improve any central facial issues.

For the nasal asymmetry I would recommend a release of the left labii superior nasalis muscle which is contracted and pulling up on the left nostril. (which. creates the snarl look) At the same time I would lower the left nostril which has also been pulled up for the same reason.

For the mouth corner asymmetry it is difficult to successfully lower the higher left side. A more effective strategy is to raise the right mouth corner to better match the left side. It is always better anyway to have a bit of an upturned mouth corner than an even or downturned one anyway.

Dr. Barry Eppley

World-Renowned Plastic Surgeon