What could have caused the "dimpling" in my lower face after facelift? (photo)

The "dimpling" you see may be due to a variety of causes. Among these are irregularities in the thickness and contour of the skin flap, necrosis of the subcutaneous fat in those particular areas, and direct adherence of the deeper layers of the skin to the underlying muscle at these locations.  There are a variety of ancillary procedures, including various types of fillers that may improve or camouflage these irregularities. I recommend you consult your surgeon about these. Good luck.

I see the issues you to which you call attention.  You mention that you did not notice them prior to the surgery.  It is important to note that it natural to be more scrutinizing following surgery, so you might just have a lower threshold for what you notice and care about.  With that said, those small areas can be addressed with fat grafting if done precisely.  Consider requesting that a homogenizer, grater collection cannula,  and 18 or less gage injection cannula be used.

I agree with the other surgeons that dimpling several months after a facelift can be due to underlying anatomy, scar tissue, or uneven removal of fat. You can fill in dimples and add volume to your cheeks using filler, but fat transfer is also an option.A small amount of liposuction is done under local or general anesthesia, then the fat is placed into syringes and injected like filler. Whatever fat survives a few months after the procedure is permanent. Sometimes it's nice to do filler first to get an idea of the amount of volume you like, and then fat grafting can be performed when the filler goes away.Fat grafting is more of a commitment up front in both recovery time and cost, but it can mean little to no need for fillers for many years. I recommend discussing the pros and cons with your surgeon and asking if you are a good candidate for the procedure at your next visit. 

Most surgeons put several buried sutures to help elevate the  deep tissues.  As the swelling goes down you may notice a small dimple over the suture.  As the suture dissolves this should resolve.  You may want to do some light massage over the area to help smooth it out.   

"Dimpling" in the first few weeks after surgery is not unusual and can be due to tension from sutures. These will resolve in almost all cases. At three months, you may be seeing contour irregularities that were previously "hidden" by loose skin-or possibly the results of fat removal in those areas. Fillers may be a good option, but be sure to let your surgeon know your concerns so he can help you. Good Luck!