Indentation in lower cheek after facelift - fat transfer did not fix it. What are the best options? (Photo)

Question

I had a secondary facelift 8 months ago. After the swelling subsided I was left with a dent in my lower cheek which gets deeper when I smile. I massaged for awhile but that didn’t fix it so I had a fat transfer. That improved it but it is still visible. Is more fat a good idea or should I have that side redone? There is a little dent (lower) on the other side but it can pass as a dimple so ok with that. Please advise

Ronald J. Edelson, MD · Answer

I’m sorry this happened to you. It’s possible that revising the facelift and separating the skin from the muscle in that area would help. The original
Undermining of the skin may not have been sufficient

Semih Yildiz, MD, FEPOBRAS · Answer

In your photo, there appears to be a visible lower-cheek depression or crease, and the fact that it becomes deeper when you smile is an important clue. After a secondary facelift, this can come from several different things: residual volume deficiency, uneven fat survival, scar tethering or adherence of the skin to deeper tissues, the vector of the lift, or a combination of these.

More fat grafting can help if the main problem is missing soft-tissue volume. However, if there is a tethering scar band or a point of adherence, simply adding more fat may give only partial improvement because the tissue is still being pulled inward with movement. In that situation, release of the tethering with a cannula or subcision-type technique, often combined with a small amount of fat grafting or filler, may be more useful than volume alone.

Before redoing that side of the facelift, I would want an in-person examination both at rest and while smiling. A full facelift revision is usually reserved for cases where there is skin or deeper tissue malposition, an incorrect pull vector, significant asymmetry, or contour problems that cannot be corrected with more limited treatment. At 8 months, many surgeons would also prefer waiting closer to 12 months unless the problem is severe or clearly stable.

A conservative option is to use a small amount of hyaluronic acid filler as a temporary test correction. If that improves the contour, it suggests volume or release-plus-volume may help. If the dent persists despite filler, tethering or deeper structural issues may be the bigger factor. Avoid aggressive massage or repeated blind filling, because that can create irregularity, lumpiness, or overcorrection.

Indentation in lower cheek after facelift - fat transfer did not fix it. What are the best options? (Photo)

Answers (2)

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