Disappointed, should facelift address lower areas of face & around mouth? (Photos)

Question

Hi! I am 44, don't smoke, exercise regularly. I picked the surgeon I thought was the best even though she was 2x more expensive than anywhere else. I had full face, neck, chemical peel. First 2 months I am very happy with my results. About month 3 a lot of what I wanted fixed started to come back. I discussed concerns with the Dr but she says my face is much better than it was and I should be happy. Should I be? What do you think about my results at 6 months? What can I do?

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. I’m sorry you’re unhappy with your results, though there is a noticeable improvement in your post-surgery photos. Since your surgery was only six months ago, it may be best to consider non-surgical options to improve the lower area of the face. Dermal fillers can restore volume and provide a subtle lift while also minimizing the lines around your mouth. This injectable treatment can be combined with RF microneedling to encourage your body’s collagen production and improve your skin’s elasticity. 
I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to review your surgical history, discuss your concerns and goals with you, and help you decide on the best treatment options.

Bhupendra C.K. Patel, MD, FRCS · Answer

Your early results are excellent. In your later photos, you see some of the changes around the mouth and the jawline: early jowls and some laxity below the corners of the mouth. 
With a deep plane face lift with appropriate fat grafting, lasers, etc, it is possible to get medium and long-term results in these areas. However, it is also important to remember that the further one is from the incisions, the more difficult it is to correct long-term changes. And these changes you point out are about as far away from your incisions as you can get!!
Having said that, it is advisable to put the preoperative, the early postoperative and the later postoperative photographs on a large screen when discussing the results with your surgeon. Most surgeons have a lot of experience with different types of faces and always aim to give patients the best results. So, If the changes are as visible as they seem to be, the surgeon will perform a revision surgery and improve this area for you. It is important to remember that early swelling and a sensation of tightness can be marked when one is attempting to get good long-term results. Many patients will ask the surgeon to be "conservative" and will want to heal quickly. This can be a mistake. So please meet with your surgeon and go over the results. Also, it is sometimes wise to wait up to six months and review the results to get a realistic idea of the results.

Stephanie Beidler Teotia, MD · Answer

You have a nice, natural result. You look rejuvenated which is what most patients desire. However, when the swelling goes away so does some of the fullness. Ask your surgeon if she would recommend dermal filler to add volume and lift to the cheek area.

Ronald J. Edelson, MD · Answer

I think you have a good result. Possibly not a drastic result because you are on the young side for a facelift. But it is a proper result

Sudeep Roy, MD · Answer

Thank you for sharing your experience. It is difficult to comment whether or not a result is good enough or as good as expected as this is to some extent subjective, even though it should be more objective. The degree of correction of the jowls, marionette folds, jawline and neck for example also can depend of age, skin quality, skin type and previous treatments. There is also the matter of surgical technique. I personally believe that the best, most durable lifts are deep plane facelifts which address the underlying cause of soft tissue descent in the lower face and are more effective than simpler SMAS techniques. You should probably give it some time, re-discuss any concerns with your surgeon and if still in a place of uncertainly, seek a qualified secondary consultation to get a proper second opinion.

Thomas Spalla, MD · Answer

I do agree that you look better overall. That being said, I can understand your concerns - particularly around the marionette lines/corners of the mouth and jowls. No one but you can say if you "should be happy." No one should tell you to "be happy." I would have a frank discussion with your surgeon about your concerns and ask her what she thinks can be done to improve your areas of concern. Some fillers or fat grafting may help to fill in some of the irregularities around that region, but be conservative to avoid looking overfilled. I wouldn't recommend jumping back into another lift; it's too early to consider something like that.

Darryl J. Blinski, MD · Answer

Nicely posted series of before and after photos. I see the issues in that you wanted a very tight lift and received a conservative though nice improvement. Revision of anterior lifting indicated with added SMAS plication. Fee $5,000. Best to virtual consult with.

Disappointed, should facelift address lower areas of face & around mouth? (Photos)

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