Ali Riza Öreroglu, MD

Based on your description and goals, the most effective way to achieve a longer-lasting, natural-looking youthful appearance would be a combination of a deep plane facelift and a neck lift. These procedures address not only the skin but also the deeper underlying tissues, helping to restore lost volume, tighten sagging areas, and redefine your jawline and neck contours for a rejuvenated look that typically lasts many years. since you have experienced significant facial fat loss, fat grafting (fat injections) can be performed during the surgery to restore volume to hollow or sunken areas, enhancing facial fullness and softness in a natural way. For the eye area, if you have concerns about eyelid drooping or puffiness, blepharoplasty (eyelid surgery) is an excellent option to remove excess skin and fat, opening up the eyes and complementing the overall facial rejuvenation. Given your height and weight, you are a good candidate for these procedures, but a thorough physical examination is essential to tailor the treatment plan specifically to your anatomy and aesthetic goals.

Based on what you've described and taking into account your history of significant weight loss and the long-standing presence of the fullness around your mouth area, it’s very likely that what you’re seeing are perioral mounds—localized fat or soft tissue pockets that sit just lateral to the mouth, often creating a heavy or aged appearance in the lower face. Given that these have been present since childhood and have persisted even through major body changes, liposuction alone may not be sufficient, especially if there is also some degree of skin laxity or underlying tissue descent (which is common after major weight loss). In your case, a lower facelift would likely be the most effective approach. This procedure lifts and repositions the deeper facial structures—not just the skin—addressing both sagging and volume displacement. It would allow for a more defined jawline and smooth transition from the cheeks to the mouth and jaw area, reducing the prominence of the perioral mounds. While you're still young at 30, your unique facial anatomy and weight loss history make you a reasonable candidate for a strategically planned lower facelift—especially one tailored to restore natural contours without making you look overdone. If needed, subtle liposuction or conservative fat sculpting can be done in conjunction, but the lifting and tightening from a lower facelift will likely be the key component for long-term improvement. Of course, to determine the exact approach, a physical examination is essential to assess skin elasticity, tissue tone, and the exact cause of the perioral volume. But based on your history and description, a lower facelift could be the most definitive and natural-looking solution.

Given the visible skin laxity and sagging in your neck area, the most effective and long-lasting solution would be a neck lift surgery. However, for a more harmonious, youthful, and aesthetically pleasing result, I recommend combining the neck lift with a facelift procedure. This combination allows for comprehensive rejuvenation of both the face and neck, ensuring a more balanced appearance. That said, the photos you’ve provided are insufficient for a thorough evaluation; to accurately assess skin quality, the degree of laxity, and underlying muscle structure, a physical, in-person examination is absolutely necessary.

An overly sharp or unnatural "V" jawline after a mini facelift is often the result of excessive skin tightening or imbalance in the deeper facial structures, such as the SMAS layer. This issue can typically be corrected with a revision facelift, where the tension is redistributed and the deep tissues are repositioned more naturally. In some cases, fat grafting can be used to soften overly sharp contours. For milder cases, dermal fillers or non-surgical options like ultrasound or radiofrequency-based skin tightening may help smooth the transition and improve the overall contour. However, a proper in-person consultation is essential to determine the best treatment plan.

At 19 years old, a facelift could theoretically address the fullness and contour irregularities above and below your jawline. However, given your young age and the fact that your skin still has strong elasticity, it's more appropriate to consider conservative options first before proceeding with such an extensive surgery. The issue is likely due to residual fat or tissue irregularities following your previous liposuction. In this case, localized revision liposuction or fat grafting (lipofilling)may help improve the contour significantly without the need for a full facelift. That said, the most appropriate treatment can only be determined after a thorough in-person physical examination.