Bulges After Face Lift? (photo)

I had a face lift 7 mts ago. I have a huge bulge on my r. cheek near jaw line and smaller one on left cheek in same area. I had fat put in my lips and believe Dr. put fat in my lower cheeks without my permission. He had tried to draw out non existent fluid in those areas twice. Now he wants to redo lift and see what is going on. I believe he knows. Can this be done evenly? I am beginning to questioning his honesty and knowledge. I am afraid I may end up looking worse. What do you think?

Doctor Answers 10

Bulging cheeks could be from buccal fat

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It's not very clear from the first two photos but I can see bulging of the cheek area on the third photo with glasses.  The right side is fuller than the left.  It seems to be above the bony jaw line.  It's difficult to diagnose over snap shots.  But if I have to guess based on this photo, I say you have pseudo-ptosis of the buccal fat.  We normally have a walnut sized lump of fat tucked under the cheek bone on each side called buccal fat.  This is deep and not connected to fat that belongs to the skin and can't be felt.  It is not seen usually.  In some individuals, the fat slides down into the cheek area.  This process is referred to as pseudo-ptosis (p is silent in both).  You can feel this lump of fat if you squeeze the area gently with the thumb and fingers repeatedly.  It should feel like something is sliding in and out deep under the skin.  The solution is removal of this fat.  It's done simply through the mouth.  It can be done under local anesthesia.  You should talk to your doctor about this possibility and have yourself examined for a correct diagnosis.  

You might wonder why this was noticed only after the facelift swelling is settled.  Buccal fats are often camouflaged by the loose excess of skin and fat near-by.  They become apparent due to the thinning effect of facelift on the jaw-line.  If you examine your before pictures you might see them there hidden among the loose tissue.  By the way, fat grafting is not a likely cause of this.

Hope this is helpful.

San Francisco Plastic Surgeon

Jawline bulges

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Either the skin flaps from the facelift were not draped properly or fat was injected into the areas you describe as bulges. In either case I would get a second opinion before having the same surgeon do any revision work. Some surgeons like to put fat along the jawline to smooth out any depressions here and that may have been done. The fat could be removed at this point with gentle liposuction to the area done carefully to avoid creating streaking. Herniation of the buccal fat pad could be a possibility.........but much less likely as the cause.

Several potential sources for the contour you describe

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Hello Peg,

Thank you for the question and the photos.  I can appreciate the areas in your after photo that you mention.  You before photos are oblique (45 degrees) and your after photo is straight on which can sometimes be deceptive.  The sources for fullness in that area is either buccal fat pad prolapse, fat graft excess, seroma/scar tissue formation, or accumulation of soft tissue from the face lift procedure.  Discuss these options with your plastic surgeon.

All the best,

Dr. Remus Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 173 reviews

Bulge in Cheek after Facelift

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    This is almost impossible to determine purely by photos alone.  Exam would give additional information as would the operative summary.  If you want a revision and want to find another surgeon, look for a plastic surgeon who performs hundreds of facelifts and fat grafting procedures each year.  Kenneth Hughes, MD Los Angeles, CA

Trust is essential to a great result and a great experience.

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Communication and trust are the key to getting the most out of your plastic surgery experience.  Only you know how you feel about what is going on.  If you have selected a top notch surgeon and the care was excellent, then you must trust to allow them to treat any problems.  I recommend going back and discussing these issues and when in doubt, go and see another local or national expert to get their opinion.  It is your face!

Jay Calvert, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 52 reviews

Face lift post operative scar tissue

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Most likely, you have scar tissue and/or sutures that did not dissolve. Ask your doctor to explain to you exactly what he thinks is going on. You should be made aware of his plans if you do decide to do a revision with him. Your comfort with your doctor is very important when doing any procedure. Seeking a second oppinion by someone who can examine you may be a good option, but time is also a huge factor. Rushing into reoperation may cause more harm than good. I usually recommend waiting 12 months to be certain all the swelling and irritation has resolved. Ocassionally, patients who wanted a revision end up very happy by 11-12 months when healing is complete and they dont have to go through the recovery process a second time.  

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.5 out of 5 stars 96 reviews

Bulges After Face Lift?

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Thanks for the question and posting the photos. First is your PS a boarded PS? Second I see the fullness in the mandibular ramus, this does have a "Jay Leno" effect. Possibly the fat grafts where placed to low and posterior to the marionette depressions (which are more anterior). If you are not comfortable with the present "surgeon" seek additional opinions. Only reoperation might help. Again Sorry. 

Bulges After Face Lift? (photo)

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Hard to see what you speak of in your photos. I do feel that because you are not sure about your existing surgeon you should at least ask another surgeon for their opinion. Your surgeon may have done nothing wrong. I have plenty of patients who have bulges and unevenness for an amount of time like you that all eventually smooth out and resolve. Trust is just so huge so if you feel your surgeon is being honest and forthcoming then you may just want to give him/her a chance to try and meet your goals.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 54 reviews

Touchups can work

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Trust is the biggest factor, it is unlikely anything 'bad' was done but if you are not confident in your surgeon, then a second opinion can never hurt. 

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 105 reviews

Face Lift Can Be Improved With Touch-Up.

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Well,you have a sense of humor!  Regardless of whether your surgeon did anything wrong or not  (he well may not have), you are losing confidence, and so you should get one or two other opinions.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

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.