Steven Curti, MD

There are several different types of face and neck lifts. Mini lifts can be done under local anesthesia quite comfortably but don't deliver the same results as a more involved deep plane face and neck lift which is typically done under general or "twilight" anesthesia. Whether or not a mini or true deep plane facelift is best for you is up to your anatomy, goals and surgeons expertise. With that being said, in my experience, without a true deep plane release you will not be able to lift heavy cheeks. I would recommend consulting with a few different surgeons and reviewing their techniques and looking at their before and after pictures to help make this decision.

Gull-wing lip lifts place the incision (and scar) right at the vermillion border which is the junction of the red and white lip. The bullhorn technique places the incision (and scar) in the junction between the nose and face, just at the base of the nose in the natural shadows. It is true that the traditional bull horn lip lift preferentially lifts the center of the lip more than the corners so people who have thinning of the lips toward the corners can sometimes get an exaggerated central look. However, the bullhorn incision can be tailored to each individuals lip shape with careful measurements and patient goals as a guide. Even designing the incision to take more laterally, I will still sometimes combine the subnasal lip lift with a corner lip lift. This avoids a scar all the way across the vermillion border and still achieves a natural appearance to the upper lip shape. Each surgeon is different and they tend to use the techniques they know best and are most comfortable with. Without examining you in person it is hard to offer an opinion on your specific situation. I hope this helps, Steven Curti, MD

Traditional incisions that were placed behind the temporal tuft in the hair line hide well, but tend to pull the sideburn into the scalp and can give a very "operated" look. Most current surgical techniques use an incision that follows the sideburn a few hair follicles in. While these can be visible upon close inspection, with a good closure technique involving no/minimal tension and proper suture placement the scars can be almost invisible. This is a question that you should ask your surgeon and be comfortable with prior to surgery. I like to show pictures of cases and exactly what the incisions look like during consultations.

It takes around a year for scars to completely mature. Until that time the scar can change. From what I can see in the pictures, there is still some redness and a raised component to the scar that may continue to improve. I would speak to your surgeon about scar management but if you are not currently using silicon gel or patches and good sun protection I would start there. Beyond those, dermabrasion or lasers all have some efficacy with camouflaging scars.

Although an examination would tell more, it is unlikely that the areas in the photograph is filler migration. It appears more likely that you are showing early signs of aging with some laxity and possibly buccal fat pad protrusion. Although injections can somewhat mask these issues I would recommend seeing a board certified facial plastic surgeon or plastic surgeon who can preform an in person exam and offer you options for treatment.