Thanks for sharing your photos!
An in-person consultation is recommended to evaluate your skin laxity and eyelid tone. Given the procedures and disappointments you have gone through, I would have you consider:
- a subperiosteal mid-face lift;
- fillers and / or fat grafting higher in the mid to medial cheek area
- I do not believe a "high SMAS" lift will be able to fill the upper cheek concerns you are concerned about.
- As you point out, facelift techniques and skills vary in lifting, stretching, redraping the nasolabial, lateral commissure and marionette folds.
Continue to search for Board Certified Plastic Surgeons with the skills to deliver the improvements you seek.
I wish you all the best!
Nasolabial folds are best treated
with fillers. Facelift improvements are directed at the jowls and neck, and
nasolabial fold improvements are secondary. I would not recommend a facelift to
address nasolabial folds and marionette lines. Fillers are the way to directly
treat those areas. Fat grafting is the best way to provide improvement because it
is your own tissue and the amount needed can be harvested. Recovery is usually
quick. Alternatively, fillers such as JUVÉDERM, JUVÉDERM VOLUMA XC, or RADIESSE
can be used but will not last as long as your own fat. It should be mentioned
that the amount of fat that survives is variable with each patient and with
each technique. Because you have tried some of these options with limited
success in the past, I would recommend visiting a plastic surgeon who
specializes in fat transfer. Best of luck.
Thank you for a great question and for sharing your photos and experience. I am sorry to hear that you did not obtain the results you wanted. The reason you are cautioned about the impact of a facelift on the nasolabial folds is that it can only soften them and there are other ways such as fillers and fat that you have already tried to address this area. A facelift will address the jowl and neck laxity very effectively if these are concerns for you. I hope this is helpful to you.
I recommend consulting with a board certified facial plastic surgeon to further discuss your concerns and options.
"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."
Thank you for your question and for sharing your experience with us. The photos are also very helpful. An in person consultation would help to determine whether a facelift alone can help with your concerns, or if adding a mid face lift to help soften the nasolabial folds and lift the cheeks would be a more appropriate solution.
Adding dermal fillers that may be longer lasting than Radiesse, such as Sculptra, can help with nasolabial fold as well. I would recommend visiting a board-certified plastic surgeon that specializes in nonsurgical options as well as facial surgery to be able to discuss your options in detail.
There are several different types of facelifts you can choose from based on your aesthetic goals and preferences regarding downtime and recovery, the risks involved as well as your facial anatomy. As a general rule, the different types of facelifts vary by the type of incision, number of tissue layers treated, the area of the face that is targeted, and their degree of invasiveness.
It is impossible to give firm
recommendations without an in-person consultation to examine the amount of
tissue laxity that you have, and it would also be very helpful to look at
photos of you in your 20's to help distinguish what is early aging changes
versus the underlying structure of your face. As others have said, some
nasolabial folds are normal, and at the degree to which you have always had
them, they are going to be essentially impossible to correct long term. I have
seen subtle skin thickening in patients with long term use of fillers in the
nasolabial folds, so aside from their temporary nature, they are not an ideal
solution. The most commonly performed facelifts do not change the mid-face, but
a sub-SMAS dissection (extended SMAS or deep plane dissection) does improve
that area in my experience, if the changes are due to tissue descent during the
aging process. I have also seen improvement with fat grafting if it's combined
with undermining of the crease, so that may also be worth trying again with
another surgeon with extensive fat grafting experience. It is wise to get more
than one opinion and look closely at a surgeon's pre- and post-op photos. Many
surgeons have far more pictures in their office because many patients want to
protect their privacy. Talk about these options with some experienced surgeons.
Best of luck.
You certainly don't need a traditional facelift. Another surgeon described a midface lift and that MIGHT help you, but that has fallen out of favor with a lot of docs (although I'm sure someone still does it and does it well). There are docs that would advocate an extended SMAS facelift to lift the cheek, but not everyone can do that either. Your NL folds will NEVER be completely flat -- you're not built for that.
From your photographs it appears that a facelift would likely be overkill for you. If you have had good results with Radiesse,
Based on your pictures I do not think that your nasolabial folds are too deep or prominent. It is normal to have some folds and complete effacement of the folds is not a natural look. You might consider a mini-facelift if you are trying to tighten your skin only. In addition, a good skin care regimen and skin tightening treatments can help augment your results.
Nasolabial folds are normal and if you think that they are too deep, then perhaps filler may improve the area.