It appears to me that a lower facelift would be adequate to address your jowls and neckline. You seem to have good volume at your cheeks and I would need to look very closely at the indentations you're talking about. There is a chance they are due to an Lymphatic blockage in that area or perhaps loss of cheek fat. Likely they can be addressed with fat or fillers.
As far as a high SMAS lift goes, if you had a smas lift in 09 I would not do it again! There are other techniques that will be safer for you at this point.
A revision facelift would help the lower face and neck areas. The cheek indentation (midcheek furrow) would likely not improve greatly with a lift alone but may improve with filling that area directly and carefully with fat or synthetic fillers such as Restylane. The swelling in the cheek area above the indentation might be improved with conservative laser resurfacing to tighten the skin, but know that it is a challenging thing to get perfect.
I hope that is helpful and best wishes,
Candidacy for revision facelift
You have a few issues. Revision facelift surgery with a high smas procedure can enhance your mid face and areas of hollowing. Fat grafting and filler can be added to further camouflage any persistent countour deformities. Your malar edema will not be improved with the facelift and can be difficult to get rid of. Micro needling and lasers may be helpful in improving malar bags in certain situations.
Facelifting #woundhealing #cosmeticsurgery #BOTOX
Thank you for your question! The indentations appear to be from the Malar lymphatic outflow- I am not sure that they will be improved with surgery.
With Warm Regards
Trevor M Born MD
You are a good candidate for a revision face and neck lift with small amount of fat grafting in malar area to improve the groove on your cheeks. These procedures can be performed with local anesthesia and twilight sedation.
Malar Bags are the Problem
You have malar bags which are giving you puffiness over your cheekbones. The dents you refer to are where the lower part of the malar bag meets the cheek. Treatment of this problem by means of fat injection is not particularly effective, in my experience. Diuretics are of some help in that they decrease the fullness of the malar bag.
As far as a facelift is concerned, a traditional SMAS Lift will improve your jowls - a high SMAS Lift is not required for jowl improvement.
Revision facelift and indention over cheek bone
Based on your pictures you would be a perfect patient for my composite facelift which includes a cheeklift/lower blepharoplasty. The strongest lift is moving the skin upwards, toward the eye. The cheekfat is preserved and and re-positioned. Once the cheek mass is re-positioned it will then resemble the high cheek mass of a youthful person. With the jowls, a plastic surgeon needs to address the deeper tissues. Instead of stretching the skin, they need to re-position what is underneath. It turns the jowls into a tightened jawline that stays youthful. Make sure you see a board certified plastic surgeon that specializes in facelift revisions. Good Luck.
You are a good candidate for a face/neck lift. A groove due to separation of fat compartments in your cheeks is not going to be significantly corrected with SMAS manipulation. However, use of fat grafts to fill this space will help. This can be done as a part of face lift surgery or as a separate procedure.
You should consult an experienced board certified plastic surgeon in your area and discuss your options. Good luck.