Dents, lateral sweep and draping skin after facelift. Will Botox help? (Photo)

Question

I am about 7 months out. I do look better than the pics now. Dr had mentioned botox as a solution. I have dents, lateral sweep and draping skin on the sides of my mouth. Thoughts? I really don't want to deal with the maintenance

David Hansen, MD · Answer

Revising the face/neck lift under local with a little iv sedation for complete comfort is the only thing that can tweek the results to the way you want it to  be.  That is why doing it under local allows you to  sit  up during the procedure occasionally to fine tune the results so later tweeking isn't necessary. cost is roughly $15-20,000 and so worth it to get  it right.

Anna Chacon, MD, FAAD · Answer

I can understand why you’re feeling discouraged. The good news is that 7 months after a facelift is still relatively early in the healing and remodeling process, especially when the concerns involve contour irregularities, lateral pulling, and draping near the corners of the mouth. The fact that you already notice that you look better now than in the photos is actually an encouraging sign.

From your description, you seem to be dealing with three separate issues, and Botox is not equally effective for all of them.

1. The “Dents” or Depressions

Small dents after a facelift are often caused by:

Scar tethering (the skin is attached down to deeper tissue)
Uneven swelling resolution
Volume loss or fat redistribution
SMAS tightening creating temporary contour irregularities

Botox generally does not improve true depressions. If the dent is visible when your face is completely relaxed, it is usually a structural issue rather than a muscle issue.

2. The “Lateral Sweep”

What many patients call a lateral sweep is a slightly over-tightened or overly horizontal vector of pull, where the tissues seem to be drawn toward the ears rather than lifted upward naturally.

This appearance can improve gradually as:

Swelling continues to soften
Scar tissue relaxes
The tissues settle into a more natural position over 9–12 months

Botox may help a little if there is excessive activity of muscles that pull downward around the mouth, but it cannot reverse the direction of a surgical lift.

3. Draping Skin Beside the Mouth

This is the area where Botox might have a role.

If the draping is partly due to strong DAO (depressor anguli oris) muscles pulling the mouth corners downward, a very small amount of Botox can sometimes soften that downward pull and make the area appear less heavy or less folded.

However, if the issue is excess or redundant skin that is physically draping, Botox will usually provide only a subtle improvement, if any.

Why Your Surgeon Suggested Botox

I suspect your surgeon may be thinking about DAO Botox, which is commonly used to improve:

Downturned mouth corners
Marionette-line tension
A “sad” or pulled-down expression

The advantage is that it is minimally invasive and temporary, so it can be used as a diagnostic treatment to see whether muscle activity is contributing to the problem.

Your Concern About Maintenance Is Very Reasonable

This is the key question: Do you want a temporary camouflage treatment, or do you want to know whether the facelift result itself is likely to improve further?

Because you are only 7 months post-op, I would be cautious about committing to ongoing Botox maintenance if you are not enthusiastic about it. Many post-facelift irregularities continue to improve for up to a year, particularly around the nasolabial and perioral region, where swelling and scar remodeling can persist longer than patients expect.

What I Would Consider Before Botox

I would ask myself:

Are the dents visible when I’m completely expressionless?
Does the draping worsen when I talk, smile, or purse my lips?
Has the area continued to improve month by month?

If the problem is static at rest, Botox is less likely to be the answer.

My Honest Impression

Based on your description, I think:

Botox is unlikely to significantly improve the dents.
It may provide a modest improvement in the lateral sweep or mouth-corner heaviness if muscle pull is contributing, particularly through DAO treatment.
It is unlikely to meaningfully correct true draping skin if that represents residual tissue laxity or scar-related contour changes.

Since you are already seeing improvement and are only 7 months out, I would lean toward continued observation for a few more months before deciding that you need ongoing Botox maintenance or a revision procedure. The perioral area is one of the slowest regions to fully settle after a facelift, and I have seen patients continue to soften noticeably between 7 and 12 months without additional intervention.

The encouraging part is that your concerns sound more like contour and settling issues than a complete facelift failure, which means there is still a reasonable possibility of further natural improvement as healing continues.

Anna Avaliani, MD · Answer

Thank you for your photos. My answer is solely on the fact that you said you don't wan to deal with maintenance .Everything requires maintenance. Surgical results are maintained by non surgical procedures. If you desire less maintenance, then you can consider a revision surgery to redo the side where the sweep is present. 
On the other hand, Botox, Sculptra and RF microneedling would tighten the skin and even out any dents.Best,Dr.Anna Avaliani

Darryl J. Blinski, MD · Answer

As I previously answered, only revision surgery can improve the results you have. Best to virtual consult with so a discussion can issue after seeing you in action live. Expect fees to range from $15-$25,000.

Dents, lateral sweep and draping skin after facelift. Will Botox help? (Photo)

Answers (4)

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