PS took large amount of subcutaneous fat out of lower face above jawline. Face is falling! What can be done? (Photo)

I have been on here before, but my face is rapidly getting worse. Had facelift in 2012 and redivision by same guy in February of 2014 due to some bulging on left cheek. He took it upon himself to remove a large amount of subcutaneous fat out of my face above my jawline. Since then my face has become sunken and the cheeks I once had are at the bottom of my face. I have been for several consults, but am getting conflicting opinions. Thanks.

Doctor Answers 16

Revision Facelift

Your prior face lift was tightly pulled along the jawline and did little to address the sagging tissues in your mid-face (cheek) region. That type of surgical approach often results in a "swept" jawline appearance as mentioned earlier in this thread. You also have a significant buccal "fat pad" that contributes to the disharmony between the sagging appearance of the cheek and the more taut jawline.  I think that you require a revision face lift with careful attention to the sagging cheek and under eye areas. In my hands, a deep plane or composite face lift works best. The source of the buccal fat excess also needs to be addressed. Fat grafting does not appear necessary but might be complementary along the lower face and jawline. Best wishes. 

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 112 reviews

Revision facelift

Hi Leisa, 

Sounds like you have had a tough time of it. The only way that I can see that you would get a lasting proportionate result would be a further revision face and neck lift. The vector of your current lift is what is causing the lateral sweep within the jowl. On the positive side  you still maintain sufficient facial volume in the lower facial third to achieve a really nice result.

Dominic Bray, MBBS, FRCS
London Facial Plastic Surgeon
4.9 out of 5 stars 169 reviews

Revision facelift

Plastic surgery is definitely part science and part art.  This is probably one of the reasons that you receive multiple opinions at multiple consultations.  I cannot speak for everyone, but here are my thoughts.

The first thing that I see that is wrong is the vector of your facelift.  On 45 degree and profile views, you have a "Nike whoosh" along the jaw line.  This accentuates the prejowl/jowl fat pad.  Removal of this fat pad is not appropriate in you. 

You will most likely need a revision face lift with redraping of the skin in a correct vector - bare minimum.

Raghu Athre, MD
Houston Facial Plastic Surgeon
4.6 out of 5 stars 89 reviews

Revision facelift

I believe you could benefit greatly from a revision facelift.  A high SMAS flap technique can elevate the tissue in the corner of the mouth and jowl area to efface this and give you a nice lower face contour.  

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Post facelift vector issues and fat loss

I'm sorry for what you have been through.  Unfortunately, every surgeon performs surgery slightly differently and it's hard to discuss why a specific approach was performed vs. another approach.  I do believe the vector, or pull of your facelift, brought some neck skin upward onto the jawline and created some unnatural lines.  In addition, there appears to be some fat reduction in the jowl region as well.  I agree with my esteemed colleagues, a revision facelift, possibly in a deeper plan to redirect the orientation of the pull would be best.  I would combine this with fat transfer though.  Best of luck!

Elbert T. Cheng, MD
San Jose Facial Plastic Surgeon

PS took large amount of subcutaneous fat out of lower face above jawline. Face is falling! What can be done?


Thank you for your question and photo, The best solution is to get a mid facelift for your lower face or to do fat transfer which will give your face more volume. it is however also adviceable to consult your surgeon.

Bulent Cihantimur, MD
Turkey Plastic Surgeon
4.9 out of 5 stars 90 reviews



Thank you for your question.

Based on your goals, you may want to consider procedures such as a revision necklift or facelift. 

I'd recommend booking a consultation with a Board Certified Plastic Surgeon to determine what your options would be.

Take care.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

It looks like the buccal fat in your face has prolapsed. Volume and structure can be added without another facelift

Thank you for your question. I understand that you had a facelift in 2012, which was followed by revision surgery in February 2014 to address some bulging in your left cheek. You describe your surgeon took out a large amount of subcutaneous fat, which left your face looking sunken and saggy, and now you’re seeking some advice on how to correct this.

I can give you some perspective on this matter as a Board-certified cosmetic surgeon certified by the American Board of Cosmetic Surgery, and I'm also an oculofacial plastic surgeon Fellowship-trained through the American Society of Ophthalmic Plastic and Reconstructive Surgery. Facelifts and the like are a big part of what I do practicing in Manhattan and Long Island for over 20 years.

Please keep in mind that my opinions expressed here are based on photos alone, without the benefit of a physical examination, so it is difficult to be completely comprehensive. These opinions also are based on my professional experience and not meant to disparage the opinions of other doctors.

Looking at your photos, my initial impression is that the bulge could probably represent herniated buccal fat, which happens often as we get older. The fat that used to provide shape and volume to the face becomes atrophic, thins out, and pushes outward in the lower part of the face.

Your doctor may have thought that the buccal fat was not as prominent, and that there was some fat in the area that needed suctioning. Reducing buccal fat is something I do during face lifting surgery as well, however I do not do much suctioning during the procedure, especially if I’m going to be doing a resection of the fat above or below the jawline. In fact, I’ve discovered that I get better results by doing a direct excision during the surgery. This is also because I feel that the fat under the skin is very important, particularly when we get older, in terms of its metabolic role and cushioning effect on the skin.

In a situation like this, you will get many differing opinions because every doctor relies on certain factors, as well as their own experiences when making recommendations. In my case, I always think of my highest values: safety, predictability, and likelihood of patient’s satisfaction. While some doctors may recommend fat grafting, I personally would not as I do not think it would produce predictable or consistent enough results.

In our practice, we perform a procedure called the Y Lift® for patients who’ve had a facelift, but feel they need more volume. This is not a surgical procedure, but uses hyaluronic acid fillers placed at a much deeper level in the face, below the muscle and just above the bone structure. This procedure effectively restores structure and definition of the jawline and cheekbones and has been met with much satisfaction from many of our patients. Understand that when we get older, we not only having sagging, but volume loss as well. With the additional fat that you lost from the surgical procedure, there is an opportunity with the Y Lift® to restore some of that volume and structure to your face without the need for another surgery. In the worst case scenario that you don’t like your results, the filler can always be dissolved with hyaluronidase.

Many doctors will have differing opinions and I certainly understand your concern and distress about that, though I think it could be worthwhile for you to explore and learn more about this option. Keep in mind it’s not about lifting anymore, but about creating a more defined structure and angularity to the face. To supplement this, I would also recommend platelet-rich plasma (PRP) to help improve skin quality and texture, which is a treatment that has also been very successful for us.

I hope that was helpful and I wish you the best of luck!

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Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Revisionary Facelift to Elevate Cheeks

I'm very sorry to read about your dissatisfaction with your results, Leisa1. Based on your photos, I believe a revisionary facelift may be able to give you the results you want. More needs to be done to address the skin of your mid-face, rather than just the jawline, which may have been the focus in your past procedure. It's important to choose a board-certified plastic surgeon who has ample experience with revisionary procedures, because these surgeries usually have additional nuances that can make them challenging. Still, I believe you can get a nice result in qualified hands. Best of luck with your revision.

James N. Romanelli, MD, FACS
Long Island Plastic Surgeon
4.6 out of 5 stars 22 reviews

Facelift - postop results

Thank you for the great pictures. It seems that you would benefit from a revision facelift & neck lift to address the excess skin along your jawline. 

#PlasticSurgery #FaceLift #Revisionfacelift 

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

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