What can cause the lines all down the side of my face when I smile? And what can be done to improve it? (photos)

I had a lower facelift in February which really helped the area directly under my chin. I am disappointed as I was told it would address the mid-face too, but it didn't. Do I look like I need another facelift? Mid-face or cheek lift? If so how soon after my liwer fsce lift can I get one? Do I just need more volume and maybe some botox? I feel like there is still too much fat in my lower cheeks. Do I need buccal fat removal? Liposuction? I'm looking fir suggestions on how to address this.

Doctor Answers 8

Treatment of expression lines in a younger patient.

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Having changes in the contour of the skin is a normal part of facial expression. I see no indication for treatment based on the one photograph provided.

Facelift #faceliftrecovery #fatgrafting #beauty #tmbcosmeticsurgery #woundhealing

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Dear Caellyn

Thank you for your question and photo!  It is difficult to tell exactly what is happening with the one photo. You are still healing from your surgery.  Please review your results with your surgeon- as they would be best to guide you in what can be done.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Face lift -

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Thank you for asking about your face lift.

  • I am sorry you are disappointed with your face lift.
  • The face lift will tighten the middle of the face but the lines in your photos are expression lines -
  • These are lines that form naturally when you smile, like crows feet.
  • Except in the mid-face, Botox can't help because it will make your face flat, as though you had a stroke.
  • Filler might help and Botox around the crows feet might soften the pull a bit.
  • I see no need in the photos for buccal fat removal or liposuction.
  • What does your surgeon say? It might be wise to wait a year from surgery before having anything done - you still look a bit swollen.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Lines appearing when you smile

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From your photo and the description you provided it sounds like the lines that are bothering you are dynamic in nature.  These lines are not responsive to surgery as they are caused by skin wrinkling over contracting muscle.  They may be improved is some cases by volume addition of improving skin tone and quality with products or skin resurfacing procedures.

Mark Beaty, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 24 reviews

How to improve lines on side of face after lower facelift?

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It would be helpful to see pictures of you when you are not smiling to give you the best advice as to possible treatment of the lines you see on the side of your face after your lower facelift.  From the picture that you did provide, your neck appears good after your procedure.  Wrinkles that form with facial movement would not respond to surgery.  If there are some lines while your face is at rest, it is possible that procedures that target the surface of the skin could help.  These would be treatments such as laser resurfacing, chemical peels or Fractora RF.  Other recommendations cannot be made without further evaluation of your face.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Facial wrinkles

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Thanks for sharing your question. I can appreciate your concern.

An important component to determine what to do is based on the animation pattern of your wrinkles. If the wrinkles are present when you smile, and not in resting position, it is unlikely that more surgery may help the process. sometimes volume may help with the problem.

Finally, make sure that your doctor is aware of your process. He should be able to guide you best in your care.

Wishing you the best in your journey

Expression lines, treatment options

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Based on the photo you provided, it doesn't look to me as if you need any additional work. Expression lines are always going to be present. If you try to remove them all, you will look like a mask. 


Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 38 reviews

Lower facelift not dressing mid face

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Lower facelift surgery rejuvenates the bottom third of the face by tightening the face’s underlying structures that slacken with age, forming jowls and a fleshy neck. It would not address your mid face . It is difficult to express an opinion based on one photo.

Walton Montegut, MD
Newport Beach Physician
4.9 out of 5 stars 47 reviews

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.