What Causes a Joker Smile After Facelift Surgeries?

A facelift, also known as a rhytidectomy, is a cosmetic surgical procedure aimed at reducing signs of ageing by tightening and smoothing the skin on the face and neck. People often opt for facelifts to enhance their appearance and boost self-confidence. However, like any surgical procedure, facelifts come with potential risks and complications. One such unwanted outcome is the so-called "joker smile."

This blog outlines what causes a joker smile after facelift surgeries and how to avoid or address this issue if it arises.

What is a joker smile?

A joker smile, in the context of plastic surgery, is an unnatural and exaggerated upward pull at the oral commissure,  the corners of the mouth, resembling the smile of the fictional character Joker. In severe cases, the joker smile may extend laterally beyond the natural contours of the mouth, creating an unnatural appearance of the mouth at rest and when smiling.

What causes a joker smile after a facelift?

Several factors can contribute to the development of a joker smile following a facelift, particularly when there are issues with the facelift technique or excessive surgical accentuation:

1. Over-tightening of the skin: during a facelift, surgeons lift and tighten the facial skin and deeper tissues. If the skin around the mouth is pulled too tightly, it can result in an unnatural upward curve, producing a joker smile. This often happens when the facelift technique creates excessive tension around the oral commissure, leading to a distorted and overly tight smile.

2. Nerve damage: the facial nerves control muscle movements around the mouth. If these nerves are damaged during the facelift, it can cause muscle imbalance, resulting in an uneven smile that might resemble a joker smile. This is because the affected muscles could either lose their function or become overly active, leading to an exaggerated expression.

3. Incorrect placement of incisions: facelift incisions placed too close to the corners of the mouth, or incisions that are not properly aligned, can create excessive tension in this area. This misalignment can cause the corners of the mouth to be pulled upward unnaturally, resulting in a joker smile. The improper positioning of incisions can also lead to an unnatural depression or distortion of the mouth’s natural alignment.

4. Inadequate muscle adjustment: a successful facelift requires not only the tightening of the facial skin but also the correct repositioning of the deeper tissues and muscles. If the underlying muscles are not adjusted correctly, it can lead to an imbalanced or forced appearance. This can cause a joker smile, where the smile appears asymmetrical or excessively tight.

5. Excessive lifting of the lower face: overly aggressive lifting in the lower face, particularly around the jawline and mouth, can create excessive tension. This surgical accentuation can distort the natural alignment of the mouth and result in the corners being pulled upward, creating a joker smile effect. Surgeons must be careful not to exert too much lift in this area to prevent this complication.

6. Scar tissue formation: after a facelift, scar tissue can form and restrict the natural movement of the skin around the mouth. This can lead to a restricted smile, where the facial skin appears tight and unnatural. Scar tissue can also cause a cross cheek depression or a pulling effect at the oral commissure, contributing to the joker smile appearance.

How can I mitigate the risk of a joker smile?

While no surgical outcome can be guaranteed, there are several steps you can take to reduce the likelihood of experiencing a joker smile after a facelift. Most patients can avoid this issue by carefully considering the following precautions:

• Choose an experienced surgeon: choose a surgeon with extensive experience, specifically in facelift procedures and a strong track record of successful outcomes. 

• Have a detailed pre-surgery consultation: communicate your expectations clearly with your surgeon during the pre-surgery consultation. Discuss the risks involved, including the possibility of a joker smile, and make sure you understand the specific facelift techniques they will use to achieve your desired outcome. Ask them to demonstrate how they plan to avoid creating excessive tension around the corners of the mouth.

• Ensure proper post-operative care: follow all post-operative care instructions meticulously. Proper care during the healing process can minimise complications such as excessive scarring or infection, which can contribute to a joker smile. Light finger traction can be used, under guidance, to gently stretch the facial skin and avoid excessive tightness during recovery.

• Discuss your concerns before surgery: if you have any concerns about a joker smile or other potential complications, voice them to your surgeon beforehand. They can explain their approach to avoiding such outcomes and reassure you of the steps they will take during surgery. This conversation should include how they plan to handle the facial muscles and avoid creating an unnatural configuration.

• Consider a second opinion: if you are unsure about your surgeon’s proposed plan, do not hesitate to seek a second opinion from another experienced cosmetic surgeon. This can provide additional peace of mind before proceeding with the surgery, as different surgeons may have varied approaches to minimising the risk of complications like a joker smile.

By following these steps, most patients can significantly reduce the risk of an unsatisfactory outcome and achieve a natural-looking result.

What should I do if I have a joker smile after a facelift?

If you find yourself with a joker smile following facelift surgery, the following steps can help to address the issue effectively:

• Consult your surgeon: your first step should be to return to the surgeon who performed the facelift. They should assess your condition, examine the facial muscles, and provide an explanation for the outcome. They may suggest corrective procedures or additional treatments to address the joker smile.

• Seek a second opinion: if you are not satisfied with the initial response, consult another experienced cosmetic surgeon for an independent assessment. They can offer insights into possible corrective measures, including revision face lift surgery, to resolve the issue.

• Consider corrective surgery: in some cases, revision surgery may be necessary to adjust the position of the facial muscles or release overly tight skin. Opt for a surgeon who specialises in revision surgeries to improve your chances of a successful outcome. This is especially important if the joker smile results from improper handling of the deeper tissues during the initial surgery.

• Explore non-surgical options: for milder cases, non-surgical treatments such as dermal fillers or Botox can help to rebalance the appearance of the smile temporarily. Lip fillers might also be used to add volume and adjust the contours of the mouth, although these solutions are typically short-term and may not fully resolve the issue.

• Seek legal advice if necessary: if you believe that the joker smile resulted from negligence or a lack of informed consent regarding the risks, it might be beneficial to consult a legal professional. Specialists who are trained in facelift surgery compensation claims such as Cosmetic Surgery Solicitors can evaluate whether you have grounds for a compensation claim, especially if the outcome has significantly impacted your quality of life.

Our expert team has dealt with many facelift cases, helping those who've suffered from negligent care to secure the compensation they deserve. We can guide you through the entire process and offer no win, no fee agreements in every case, ensuring you are at minimal financial risk when you decide to claim with us. Call us today on 0808 273 2705, or fill out an online contact form to arrange a time for us to get in touch.