PS took large amount of subcutaneous fat out of lower face above jawline. Face is falling! What can be done? (Photo)
Doctor Answers 16
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.
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.
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.
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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!
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.
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.
It looks like the buccal fat in your face has prolapsed. Volume and structure can be added without another facelift
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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