Five months on and my bottom lip still doesn't come down properly on one side when I smile. Everyone said three to four months. Is that it now?

SMAS lift on 10 March, and by almost every measure I'm delighted. Neck sorted, jaw sorted, nobody has asked what I've had done, three people have asked if I've been away.

The problem is my smile. When I smile properly, the big involuntary one, my bottom lip pulls down on the left and stays put on the right. Resting face, fine. Talking, mostly fine. Smiling in a photograph, and my mouth is visibly crooked and it is the only thing I can see. It has been like this since about week two, it improved a bit somewhere around month two, and since then, as far as I can tell, nothing.

Everything I was told and everything I've read says these things settle in three to four months. I am at five. So the question I've been avoiding asking out loud: is this now permanent, and I should get on with learning to smile a different way? Or does it keep improving after the point everyone quotes at you and I'm being impatient again?

(I know, I asked this forum about swelling being impatient too. Consistency is a virtue.)

Not the same as yours but adjacent, so for whatever it's worth: mine was the other end, the eyebrow. For about ten weeks my left brow would not go up when I was surprised, which made me look permanently unimpressed on one side only. It came back so gradually that I genuinely cannot tell you when it finished, I just noticed one day in about month four that both eyebrows were working and I'd stopped checking.

The reason I mention it is that "no change since month two" is much harder to judge than it feels, because you see your own face every day. Have you got a photograph of yourself smiling at week six or so? I found comparing month four against a picture from week five much more informative than comparing it against my memory, which turned out to be useless.

Two years out and I want to gently push back on one bit of the framing, Vivienne, not the medical part but the "learning to smile a different way" part.

You've described a face that has fixed the thing you paid it to fix and is doing one thing you didn't ask for. That's a genuine complaint and worth pursuing properly. But do go and pursue it with him rather than deciding privately that it's permanent and quietly rearranging your life around it, which I did with something else entirely and wasted about a year on. Book the appointment. Ask the direct question. He will have seen this before, and either the answer is reassuring or it's the start of a conversation about what can be done, and both of those beat five months of guessing.

Vivienne, the honest answer is that five months without change is worth a proper review, and it is still too early to call it permanent. Both of those things are true at once, and I would rather you had both than a false reassurance.

What you are describing has a name and an anatomy. Temporary weakness of the facial nerve branches is the more common nerve problem after a facelift, and the branches most often affected are the one to the forehead and the one to the lower lip, which is the pattern in your post and in Cheryl's. That is why the lip does not pull down evenly when you smile while the rest of your face behaves normally: it is the muscle that depresses the lower lip on one side not being driven properly, not the lift being uneven. Permanent nerve injury after a facelift is rare, on the order of 0.1% or less, and the great majority of these weaknesses recover within about 3 to 4 months. That figure is a typical range and not a deadline, and recovery running longer than it does happen, which is precisely why a surgeon reviews rather than discharges at that point. The site's account of this sits in facelift risks and complications.

What varies the timing, named precisely, since "it varies" on its own is useless to you. Whether the nerve was stretched, compressed by swelling, or affected by the local anaesthetic and the dissection itself makes a real difference to the pace: the first two recover on their own timetable and the pace is set by the nerve rather than by anything you do. Ordinary recovery is typically gradual and partial before it is complete, which fits Cheryl's description of not being able to say when it finished. What is less typical is genuinely no change at all across three months, and that is the specific thing to put to your surgeon, because it changes the conversation from waiting to assessing.

So the practical answer. Go back to the surgeon who operated, tell him the timeline exactly as you have written it here including the month two plateau, and take Cheryl's excellent suggestion with you: photographs from week six, month two and now, smiling the same way in each. Objective comparison of your own face over months is very hard without them and very easy with them. Ask him directly whether he thinks this is still recovering and what he would expect to see by when, so you have a marker rather than an open-ended wait.

What I cannot do from here is examine which branch is involved or how it is behaving, and that examination is the whole of the answer. Nothing you have described sounds like an emergency; it sounds like something that has earned an appointment rather than another month of watching.

The photographs advice is the best thing in this thread and I want to underline it, because I did the opposite and it cost me months of misery.

I judged everything against a memory of my face from before, which is not a real reference point, it's a flattering composite of about fifteen years of mirrors. When I eventually lined up actual photos in order I could see improvement that I had been completely unable to perceive day to day. Not on this specific issue, mine was the swelling, but the mechanism is identical: slow change is invisible from the inside.

Also Vivienne, from someone who has read your posts here for a while now: you were right to be impatient about the swelling and you might be right this time too. Being the person who asks is not the same as being the person who panics.

Appointment done, and I'm reporting back with a genuinely mixed result rather than a tidy one, because I think the tidy ones are misleading.

I took the photographs. He was pleased about the photographs. And looking at week six against now, there IS improvement I could not see, not loads, but the crookedness in the wide smile is measurably less than it was, which I would have sworn on anything was not the case. So the month two plateau was partly me looking too hard at too small a change.

What he wouldn't do is promise me it finishes. He said he'd expect further improvement and wants to see me again at nine months, and that if it's still there at a year we'd talk about what, if anything, is worth doing. So I don't have an answer, I have a date, which is not nothing. And I've stopped avoiding cameras, mostly.