Face and neck lifts are widely utilized procedures in facial rejuvenation. Facial weakness remains one of the most feared complications, and transient lower lip weakness remains the most common weakness seen after these procedures. In the past, lower lip paresis was regarded as stemming from marginal mandibular nerve weakness. However, recent intraoperative studies using distal facial nerve branch electric stimulation have demonstrated that the cervical branches of the facial nerve provide the primary innervation of the depressor labii inferioris muscle; and injury to these branches may result in lower lip weakness. Therefore, understanding the anatomy of these cervical branches, and how to preserve them during face and neck lifts, is critical to limit post-operative facial paresis. This paper describes our current understanding of depressor labii inferioris innervation, its relevance to face and neck lift procedures, and strategies to prevent and manage inadvertent injury to the cervical branches of the facial nerve.