I had a neck, cheek and brow lift. Now, my jowls are next to the corners of my mouth. The surgeon said he Liposuctioned the saggy skin and it will take 9 months for the skin to tighten back up. Does that sound right? I don't think he did the cheek lift, since the whole center of my face is drooping, leaving me with a heavy lateral sweep on one side and loose skink on the other side. Is it possible that the surgeon was so careless, so I ended up with an uneven result? Can this be corrected?
Uneven Results from Cheek Lift Procedures
Doctor Answers (8)
Procedures are only collections of surgical maneuvers
When a patient or doctor says they had a facelift, or a cheek lift, or a neck lift, it doesn't explain the surgery itself nor the rationale. Cosmetic surgery is simply applied anatomy. You have to define the anatomical problem, delineate the desired goal or result, and then devise surgical maneuvers to accomplish the anatomical changes. What you then call it is relatively generic.
It sounds like the surgical maneuvers did not match the anatomical problem or were inadequate to achieve the desired effect. Asymmetry is not uncommon and is, in fact, exprected to some degree in every patient. But if the results did not match the expectations, there was probably a planning problem. You have to remember that all parts of the face are chronologically aged so if you ignore certain anatomical areas in your planning, the results can be disharmonious and unnatural not only because you are not correcting the aging features in certain regions but also because the surgeon may have a tendency to correct those regions by over-extending others. This happens commonly when surgeons try to address mid-face issues with traditional neck and lower face "lift" giving an exaggerating look to the "lifted" areas.
A careful anatomical analysis of your current situation and meticulous discussion of what you want to look like is in order. Remember, the surgical maneuvers are subservient to your anatomy and your desired result, and not the other way around.
Revision facelift surgery
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.
Hard to tell...
Without pre and postop photos of you, your questions are really hard to answer. All I can suggest is that you work closely with your surgeon to see you through until your final healing has occurred, usually about 6 months. At that point, your result will be essentially finalized.
If you are not pleased at that point, see what your doctor suggests. Hopefully, you chose a well regarded doctor who did a good operation and will give you a nice result in the end.
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Uneven Results from Cheek Lift Procedures
After a cheek lift is performed by any method it may be a while before the areas are settled and in the stage of their final results. It is best to wait awhile for everything to settle down before scrutinizing the result.
Round broad faces are the most difficult to improve the jowls
Your picture indicates that you have a round and broad face. These are the hardest to get and maintain good elevation of the jowls. It is simple physics - the jowls are heavy and the pull is coming from further away in any form of face lifting due to the width of the face. We try to warn patients in advance that they may need fillers after the swelling goes down to smooth out the transition of cheek to jowl.
Don't judge the results of an operation (cheek lift) too early.
From your picture, you are still in an active phase of healing where a good deal of change is anticipated. You should remain patient and consult with your surgeon to make sure he feels you are where you should be in your recovery.
It is difficult to tell from your photo. If you are unhappy with your results, go get a second opinion from another surgeon. Remember, asymmetry of the face is normal. One side can look slightly different from the other side. I always point asymmetry out to patients before surgery because they will often have a heightened awareness of it after surgery.
Get a second opinion
From the information you have supplied it sounds like you may require a second opinion. The two sides of the face are never the same. But one should have mild differences of the two sides for several weeks after surgery. What you describe sounds like more than that. Yes, it can be improved if it turns out that it is more than just normal differences of the two sides.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.