Follow up to earlier facelift question

I posted an earlier question about asymmetrical swelling following a full face and neck lift with fat grafting. 9 days later (4 weeks post op) the swelling is resolving but I'm left with a fairly deep oral commissure on the formerly more-swollen side. (My surgeon had tried to fill it a couple of years ago with a hyaluronic filler but to me it actually made it a bit worse). I assumed it would be taken care of during my facelift but it is just as deep and long as before. Can this be fixed?

Doctor Answers 10

Post facelift surgery

As a general rule, the more procedures one has done at the same time as facelift, the greater the chance that an increase in bruising and swelling will occur, and thus a little longer healing time. Four weeks post op there is moderate amount of swelling that may subside with time. You best option is to talk to your surgeon.


Orange County Facial Plastic Surgeon
4.9 out of 5 stars 186 reviews

Swelling after facelift

At four weeks postop, you are likely significantly swollen. I would suggest waiting several more months before drawing any conclusions or attempting to correct any areas of perceived asymmetry. Speak to your plastic surgeon about your concerns.

Lara Devgan, MD, MPH
New York Plastic Surgeon
4.9 out of 5 stars 14 reviews

Addressing your Concerns

Hi Helloarizona

It is difficult to give you an exact answer having not seen or examined you. This is best done by experienced surgeon who performs face lifts and fat grafting regularly. The swelling from the facelift can vary depending on the technique and surgeon, however by 4-6 weeks the swelling should have subsided and you will be able to assess the symmetry more accurately. Prior to 4-6 weeks the asymmetry can be due to handling of one side more than the other and in the case of fat grafting there is an element of fat survivorbility which can be unpredictable and can fully be assessed at 2-3 months.

As for the deep crease this can be due to underlying tissue realignment and tightening and possibly adherence of the skin to the underlying muscle layer. Most creases can be improved or fully corrected but this will need to be done by the experienced surgeon competent in performing revision surgery. If your surgeon is not sure about being able to correct this - it may be worth while getting a 2nd opinion from a revision surgeon.

Swelling after a facelift and fat injections

 When a facelift and fat injections are performed together, there is significant swelling the takes many months to settle down from the facelift itself, and integration of the fat grafts into their new position in the face. Without a set of photographs it's impossible to give any opinion. It is very difficult to stretch out a wrinkle next to the oral commissure from a facelift without making patient's look unnatural.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 129 reviews

Facelift questions and answer

Its difficult to answer this question without up to date photos.  In general it will take up to a few months for all swelling to settle following facelift surgery.   If you notice persistent folds in the region of the oral commissure this may require further augmentation with facial filler after all swelling has subsided.  Facelifting will deal mostly with the neck and lower face and  jawline.  Folds around the mouth often still require filler or fat grafting for optimal results.

Philip Solomon, MD, FRCS
Toronto Facial Plastic Surgeon
4.3 out of 5 stars 83 reviews

Follow up to earlier facelift question about oral commissure asymmetry

Many times, deep nasolabial folds and oral commissures can be improved, but are not eliminated after facelifting. Asymmetries present preoperatively tend to persist due to differences in bone and soft tissue anatomy in the different sides.

Asymmetrical result after face lift

Thank you for asking about your  face lift.

I am sorry the surgery and fat grafting don';t seem to have solved your problem.
It sounds as though surgery was recent.
You cannot tell your final result for 6 months at least -
it will be difficult to tell what, if anything, is needed before then.
No face is symmetric and mild asymmetries will often persist because of underlying tissue differences.

Always see a Board Certified Plastic Surgeon
Hope you found this answer helpful. Best wishes.

Swelling after facelift

Swelling after facelift can take several months to go down.  If there is an area that you are concerned about, please discuss with your surgeon.  Having said that, if you were able to provide some photographs, we would be better able to provide an opinion on what might be possible.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
5.0 out of 5 stars 32 reviews

Deep oral commissure

If the oral commissure was deeper on one side prior to your surgery (it sounds as if it was in your description), that will most likely still be the case following facelift surgery.  In general, with facial surgery, asymmetries tend to remain to some extent despite surgical intervention.  There may be a secondary supplemental procedure in addition to or instead of filler that may help to address this problem.  Good luck!

Scott K. Thompson, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 99 reviews

Making judgments about a facelift for weeks after the operation.

 It sounds as though you're going to have to consider some other solution but it for weeks there still swelling and you should remain patient until the final aesthetic product has been realized. If another approach to the problem is to be considered, you might want to post pictures  Atthat time on this website.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

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.