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What is this soft saggy spot on cheek when I smile? Can this be fixed under local anesthesia? (Photos)

I had a SMAS facelift 1 year and 6 months ago. Unfortunately I had really bad results with pixie ears and this soft spot developed after healing? The surgeon have not addressed this concen so am wondering or answer what it is. ? I had a revision done locally with same surgeon to try and fox pixie ears by only made ear worse. Am wondering if It is connected to the pixie ears ? Lack of tightening og SMAS or what can cause this and how to fix it? Really do not want a full revision done. Looking og in office / local anesthesia procedures. Thank you

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