The issues involved in revision face surgery are complex. When we evaluate patients who were unhappy with their facial surgery, we look at the before and after medical pictures taken in the doctor's office, and look closely at what procedures were performed by examining the operative notes of the procedures. The reputation of the initial surgeon also has a great bearing on deciding what further procedures to undergo, if any.
Often, it is not clumsiness on the part of the first surgeon, just the selection of procedures and their outcome on the face. Sometimes patients' expectations are different from what could have been delivered with the procedures selected.
Patients having a cheeklift and a neck only procedure through an incision below the chin usually will have no benefit at all in the jowl area. Some patients who have a cheeklift and a necklift performed through incisions behind the ear develop an odd direction of pull due to the fact that nothing was done for the face itself, just the neck, and the neck skin was pulled up and back, often creating an odd collection of jowl tissue around the mouth. This creates a disharmony in the face, and is one of my criticisms with face-only or neck-only minilifts.
For a complete discussion of cheeklift procedures, we have several published articles and book chapters on our website drbrent.com under "Articles" that can at least raise some issues that are important with first time and revision cheek surgery.
The good news is that in expert hands, revisions of these procedures typically have excellent outcomes. In the process, your surgeon will guide you through what procedures should be used for the revision. Is volume repletion (i.e. LiveFill) necessary in the marionette region or lip area or area around the mouth due to loss of facial fat? Is a multivector facelift necessary to correct jowling? Did the cheeklift achieve the desired result or did it change the eye shape in an undesired direction? What type of cheeklift was performed? Are the scars and hairline patterns satisfactory or should they be revised? Does hair need to be restored at sites of surgery? Does the face have a "done" appearance, and if so how specifically should it be addressed?
You will want to make the next move carefully, and will likely want to have clear answers on all the questions above before proceeding with any revisions. Avoid doctors who blanketly criticize the work of others and come up with a plan without taking the time to learn about your past surgery by reading your old records and examining photographs. No doubt you know to start with a select group of board certified plastic surgeons who have great experience and interest with revision facelift procedures and the many complex issues associated with them.
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