When you get a face and neck lift should the jowls end up in your lower face causing your face to look super fat? 3 months p.o.

Question

had a neck lift and face lift nov 30 and did not have double chin, just jowls and turkey neck, wanting to look refreshed. Also had upper and lower eyes done. My eyes came out looking like 2 different eyes, and my jowls ended up in my lower face causing me to have chipmunk cheeks. What are my options now?

Michael Boggess, MD · Answer

Hello.  Thank you for your question.  I am very sorry to hear about your concerns and dissatisfaction with your facial rejuvenation procedures.  It is really impossible to make any assessment of your concerns without pictures.  Front and side pictures with your head in a neutral position would be helpful.  In general, facelift should not necessarily make your face look more fat, unless there may have been fat injected into the face at the time of the procedure for volume restoration.  There may be some swelling that is still present postoperatively that could make your face appear more full than normal.  If it is due to persistent swelling, then that should improve with time.  It can take up to several months for all of the swelling to resolve following facelift.  Another thing that can make the lower face appear more fat is prominence of the buccal fat pads.  These fat pads sit lateral to the corners of the mouth and can give the appearance of "chipmunk cheeks" in some patients.  The buccal fat pads are not routinely addressed in facelift surgery.  However, they can be addressed through a simple procedure called a buccal fat reduction that involves a small incision inside the mouth through which the prominent buccal fat can be removed, and provide improved shape to the lower face.  I would strongly encourage you to voice your concerns to your primary surgeon and see what they recommend to help improve your satisfaction with the results.  It may simply require some additional time to allow things to heal and swelling to resolve.  I hope this is helpful.  I wish you the best in your recovery.

Nelson Castillo, MD · Answer

Thank you for sharing your question and I am sorry that your results have not been what you anticipated. Unfortunately after 3 months you have largely reached your long-term results and it sounds as if a revision procedure may be needed.  Typically your jowls are corrected as part of the muscle tightening portion of the procedure and should me smooth, accentuating your appearance and not making your lower face look “fat.”  Talk to your surgeon about your concerns.

Garrett Griffin, MD · Answer

It is best to start by talking to your surgeon about your concerns.  If your surgeon doesn't offer to address your concerns, you should seek out a second opinion from someone experienced in revision cosmetic facial surgery.  By 3 months out from your surgery, facial swelling should be gone so this isn't swelling from the surgery anymore. That said, in my experience it is best to wait a year before performing a revision surgery.  Best of luck.

Susan Buenaventura, MD, FACS · Answer

Jowls are best addressed by removal of the fat and tightening of the skin.  If you have already undergone a facelift then the skin should be tight.  You may need additional fat removed.  This can be accomplished with microliposuction of the area.  You may still have swelling.   Follow up with your surgeon and consider revision at about 6 months.

David A. Sieber, MD, FACS · Answer

At 3 months after surgery 80-90% of the swelling should be gone. Repositioning of the jowls into the lower face does not usually happen if the surgery is performed properly. Without seeing photos, it's difficult to know what may need to be done to get you a better result. Something as simple as facial liposuction may be all that is needed. I recommend bringing up your concerns with your surgeon.Best,~Dr. Sieber

Benjamin W. Cilento, MD · Answer

Hi
    I am sorry you had a bad time after surgery. I cant make any comments about the post op result without pics but if youre not happy you should talk to your surgeon. You should be happy with your jawline and submental region. If you arent then you should seek a revision appointment.
Dr C

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  Non smiling photos of your face from the front and side would help in the evaluation but no, the jowls should not appear larger (rather they should be smaller and less obvious) after a proper SMAS facelift as described below.  You may want to discuss this with your Facelift Surgeon to see if perhaps fat was injected in the mid and or lower face during the facelift which would explain what you are describing.  Because fat is not reliable, I do not believe that it should be used for facial shaping as discussed below. 
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheeks that are flat or concave in the front can be augmented with a dermal filler or by using silastic cheek implants (permanent enhancement) to create full, round cheeks that will feminize the entire face.
 If the chin is weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective. I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years.  In my experience and despite its recent increase in popularity, fat transfer (fat injection) offers "far" less of a reliable and predictable volume for facial shaping than an off the shelf dermal filler or silastic facial implant.  For that reason, I do not use fat to shape the cheeks, chin, lips or jaw line.  Tissue physiology is quite simple.  Tissue requires a blood supply in and out as well as lymphatic connections to remain viable and alive.  Once fat is removed from the body all of these things have been disrupted.  Just because the removed fat is mixed with PRP or something else doesn't make the blood and lymphatics magically re-appear.  The fat at that point is not living tissue which means that it's prone to being dissolved by the body (most likely in an uneven and unpredictable manner).  Injecting fat back into the face does not create the required elements to make the fat living tissue once again.  So the argument that fat is alive and viable in the face once it's been removed and re-injected makes no sense to me as a physician and surgeon.
 The other issue that I have with fat transfer is the lack of precision.  Fat is thick by nature which means it's not the same consistency as an off the shelf dermal filler.  Fat injections use an increased volume injected in an attempt to compensate for the volume loss that "will" happen.  This means a lack of specific shape and volume that simply can not begin to compare with the specificity of using a silastic facial implant of a "known" shape and volume.  In that regard fat offers too much of an unknown to make it a reliable and predictable method for facial shaping.  There's a significant difference between a 3mm and 5mm thick cheek implant.  You can imagine the magnitude of difference there is between retaining 60% of 25cc's of fat versus 35%.  In my humble opinion, I just don’t see how fat could possibly be used to precisely shape facial features?
Hope this helps.

Trent D. Douglas, MD, FACS - Account Suspended · Answer

Redistribution of facial and neck skin is a large part of facial rejuvenation surgery.  Having a detailed discussion with your surgeon regarding your results is the best thing now 3 months out from surgery.  Your swelling has likely resolved by this point.  Although long-term results can take up to 4-6 months to be fully visible, your results at 3 months are a pretty good idea of what things are going to look like.  Have an open discussion with your surgery about your concerns and come up with a plan together.

When you get a face and neck lift should the jowls end up in your lower face causing your face to look super fat? 3 months p.o.

Answers (8)

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