Thanks for the comments! I have made some adjustments to this today, including increasing detail of her face and adjusting parts of her nose a bit. I found this to be a really tricky perspective - it's the face from below, yet her open mouth extends her entire lower face dramatically. It's rare to have one's mouth so widely open so it's also a useful exercise to try to show teeth without it looking like a prosthesis. I'm quite happy with how the expression came out in the end.
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I love the tension in her neck muscles. It is so realistic.
I found that it makes a lot for the expression - the shape of the neck seems to be quite a big part in how we interpret impressions.
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most believable painting of someone in distress, I can't gaze at her for more than a few seconds - start feeling her pain.
Artist's goal achieved
Human emphathy is a strange thing. I too find I subconciously grimace a bit when really looking too closely at this.
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The only thing that bothers me a bit is the space between her nose and mouth, I feel like it needs a little more space
Thanks for the feedback! This is a rather unusual perspective, we are not used to seeing it quite like this very often. We are seeing her from below, as evident from our full view of her nostrils. On top of that her mouth is wide open, showing her teeth all the way up to her gum. I'm pretty sure the foreshortening of her upper lip is correct from this angle, but I'll ponder it for a while to see if I start to agree with you.

Thanks again.
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Griatch