My perioral mounds are very prominent, marionette lines very deep, and my face is very thin. What can be done to help? (Photo)

If I were you I would be dissatisfied with the aesthetic result of the facelift based on the photograph provided. A revisional procedure will be necessary that will address the deeper structures and removed tension from the skin.

Your early results really looked very nice and so one question is have you had any weight loss or was fat injected in some areas that may have not survived the transfer long term.  The left cheek seems to demonstrate some fullness almost like a herniation of fat in the buccal area and the right side looks a little thin.  I agree that it is difficult to judge everything on line, but suspect some volume addition to areas of the face and perhaps addressing the bulge in the left cheek might be helpful. A secondary facelift to address some of this may not be out of the question

as your thinner, more angular face looks pretty good as well.  If you are desiring going back to what you were, it will take fillers or fat grafting.  Resurfacing (if you are accepting of the risks) can also help smooth skin and diminish lines.  Or as everyone else has mentioned, you can have another facelift but I prefer the more conservative approaches at this point.  You can discuss your concerns with your surgeon as your surgeon will ultimately be the one doing this.

It would be helpful to know exactly what was done in these two facelift procedures. But now there appears to a volume-skin excess mismatch. Based on your description in your inquiry was buccal fat removed during the revision or was it the perioral mound area? You mentioned subcutaneous fat but it is not clear where that was done exactly. Most likely volume addition is needed by fat grafting to restore some facial fullness but there is not enough known information about your prior procedures to give any specific recommendations just yet.

Very hard to advise in great detail via the internet. Appears as a mid face lift plus Voluma fillers are needed. Or fat grating. Best to seek a few IN PERSON opinions. 

Tomy eye, you have the appearance of a skin-only lift with limited undermining no deeper tissues (SMAS) repositioning. This may or may not be what you had. While fillers may help the area above the neo-jowls, they are unlikely to meaningfully change these jowls. I would likely do a secondary facelift with retensioning the SMAS layer vertically and redraping your overlying skin more fully. Iff fillers were indicated to further improe on the result, I would do them later.

After looking at your photos, and your history, in my opinion the result and concerns you have is the result of the fat removal you had during your facelift.The last thing I would recommend is further tissue removal, like buccal fat pad excision.There is no easy solution, but your best one is to try and replace some of the tissue loss with either a filler, or fat to try and re-contour your face.Best of luck.

Considering your case and evaluating your pictures, I notice that there is quite a bit of midface volume loss and facial descent. I would recommend facial fat grafting to correct the volume loss and revision facelift to resuspend the underlying subcutuaneous fat and muscle. This combination therapy showed give a lasting effet.