Why did jowls return after facelift revision? 60 year old woman. (Photos)

Question

Had a full facelift 1 yr ago. Jowls returned so Dr agreed to lower facelift revision at no cost after 1yrs time. Had procedure, local anesthesia, didn’t feel pain but could feel pulling. Excruciating pain after, a few days only. Day one I looked GREAT! But a little after a week, noticed jawline softening and jowls returning. I am devastated. Dr suggested could be swelling, have to wait. Wonderfully Skilled surgeon in major US city. Pic 1+2 are 1st day. Why is this happening?

Gurkan Kayabasoglu, MD · Answer

Hello,It is needed to be known the techniques used in your surgery. Some people have skin that is inelastic and no matter how much you pull on it and the deeper structures, they develop recurrent laxity. However, a deep plane tecnique in the expert hands will achive your desired appearance and you can consider a chin implant as well to achieve more balance on your face. Be sure that your surgeon is an expert facial plastic surgeon.

Marc Pacifico, MD, FRCS(Plast) · Answer

Many thanks for posting your question, but I am sorry to hear of your disappointment with your result.It is hard to give you a precise explanation without understanding the techniques used in your surgery, or have an in-person examination with you.However, in general, once you have reached 60, and your skin has lost its elasticity, perhaps with contributions from sun damage and maybe past smoking, the inherent qualities of your skin and soft tissue play a significant role in the longevity of the result of any face or neck lift.The best thing to do would be to have a discussion about your concerns with your plastic surgeon. I hope this helps.

Zoran Potparic, MD · Answer

Jowls are located in the area where a branch of facial nerve (major nerve to innervate lower lip muscles) is located. For that reason surgeons are, in general,  very conservative when treating this large fat pad.In our experience this can be corrected at least 6 months after surgery with liposuction. We use small, 1-1,5 mm cannula to sculpture this area and jaw line. Discuss this option with your surgeon, it may work. Good luck.

Edwin F. Williams, III, MD · Answer

So sorry to hear about your disappointment following this procedure. I always encourage patients to express their feelings in an open and honest discussion with their surgeon if possible. There are, of course, many different ways to perform a facelift that are more or less effective depending on the patient's anatomy and goals. If you are looking to treat heavy jowls and loose skin in the neck, I typically recommend a lower face and neck lift. This involves partially mobilizing the muscular SMAS layer below the skin and resuspending it with a posterior, superior vector to give a very natural, refreshed looked. This type of lift permits significant improvement in the jawline as well as excess tissue in the neck that can be difficult to obtain with other commonly used techniques. I tell patients to expect results to last 10-12 years. Hope this helps!

Ben Lee, MD · Answer

Sorry to hear that your early results were not maintained, because your day 1 photos are excellent. I think you have a couple of issues here. Some people have skin that is inelastic and no matter how much you pull on it and the deeper structures, they develop recurrent laxity. You may be in this category. Your other problem is that you have excess bulk in the jowl area. By tightening the SMAS (supporting layer) along the jawline, the vast majority of people can dramatically improve the jowl area. Some people, however, have so much tissue in the jowls that they don't have the smooth jawline they want. I have revised a couple of patients in this situation by carefully excising the jowl itself after the SMAS has been repositioned. I doubt that you would want to go back and have that done in your situation, but perhaps liposuction of the jowl is an option for you to discuss with your surgeon after you have had a chance to fully heal.

Trevor M. Born, MD · Answer

Dear SJ32Thank you for your question and photos!  This sounds like you have had 2 surgeries without the result that you anticipated.  It would be good to see your photos before the first surgery.  It is possible that your skin elasticity is poor and no matter the procedure - you may still have some laxity.  A second in person opinion may be helpful.With Warm RegardsTrevor M Born MD

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question and pictures.  Unfortunately, patients skin do behave differently, as everyone has different skin qualities.  At 60 years of age patients skin quality is normally quite poor, as skin has lost elasticity, therefore the longevity of a facelift will not last as long as someone at the age of 50.  This is not to say that a facelift should only last 1 year.  I would suggest having some contour to your face before addressing the skin.  Liposuction could be use to create some contour and definition in the face beforehand.  Please make sure you find a reputable and qualified plastic surgeon.  All The Best.

Karan Chopra, MD · Answer

I'm truly sorry to learn about your experience and the return of jowls following your facelift revision. It's natural to feel disappointed, and I encourage you to have an open and candid conversation with your surgeon about your concerns if possible.

Facelift procedures can vary significantly based on individual anatomy and desired outcomes. To effectively address heavy jowls and loose neck skin, a lower face and neck lift is often recommended. This approach involves carefully adjusting the muscular SMAS layer beneath the skin, repositioning it with a specific vector for a natural and refreshed appearance.

This technique offers substantial improvements in both the jawline and the excess neck tissue that can be challenging to target with other methods. Typically, patients can expect these results to last between 10 to 12 years.

If you're considering exploring further options or discussing your situation in more detail, I'm here to provide insights and support. A consultation can help us evaluate your unique needs and tailor a plan that aligns with your aesthetic goals.

If you have any more questions, feel free to reach out to me at chopraplasticsurgery.com.

Douglas J. Mackenzie, MD · Answer

I wonder if a chin implant was ever discussed with you.  Although there is no profile photo, it seems that your chin is comparatively small and under-projecting, even in what appears to be your post-op photos.  I would evaluate your chin along with the way your dentition lines up.  With a weak chin, jowls tend to show up earlier in life, and be more difficult to treat, unless the chin is augmented to balance the jowl fullness.  There is always some relaxation after a facelift, and if the structures (a weak chin, or flat cheekbones for examples) underneath the tissue haven't been addressed, the results can be disappointing.

Val Lambros, MD, FACS (retired) · Answer

Jowls look simple when pulling in a mirror, unfortunately they do not respond in a similar way in real life. Thr problem is that there is a fat pad there which can only temporarily be hidden by traction and swelling.  In my experience this fat pad need to be reduced diractly as well as filling the areas in front of and behind it. Waiting is a good idea for the next 4-5 months regardless.

Why did jowls return after facelift revision? 60 year old woman. (Photos)

Answers (11)

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