Sunken area 2 years after facelift - what could have caused this and can it be treated? (photos)

Question

I had a facelift two years ago and and I am left with a verticle type dent (not a diagonal cross dent toward my ear). I would like to know what caused it, what it is, and how it should be treated. Thank you.

Zoran Potparic, MD · Answer

It is very likely that one of the major ligaments that connect skin and deep facial tissue is not completely released? Correction can be achieved either with partial face lift approach or transcutaneous, using a small fork cannula. It is in your best interest to discuss this with your surgeon first and/or schedule a second opinion consultation with an experienced face lift surgeon. Good luck.

Thomas A. Mustoe, MD, FACS · Answer

The likely cause of the dent is deeper sutures that were utilized to lift the superficial muscle fascia later (SMAS). At two years the depression is not going to resolve . The options are to release the SMAS and realist through a deep plane approach (secondary deep plane facelift or fat transfer or both.  The depression can be greatly improved but not completely corrected.

John Michael Thomassen, MD · Answer

It is hard to say without knowing what procedure you had done.  Is this visible only when you smile?  I would suspect you had SMAS plication or a MACS lift that placed sutures across the SMAS.  If the tightening of the SMAS did not correspond with the skin tightening, you could get this type of disparity.  A revision to retighten the skin should correct this.

Tanveer Janjua, MD · Answer

A depression can happen from scar tissue that is pulling the skin inwards. It can happen from loss of fat in the area as well. Occasionally there can be a stitch holding the skin down. 
The best way to treat it is fillers. Fat transfer can help as well. 
Regards
Dr. J

Patrick Felice, MD · Answer

It appears that the indentation is the result of how the skin was draped in front of the ear. This is not uncommon and should be correctable with a slight revision. Hope this helps.

Stefan Mark Szczerba, MD · Answer

I that's called "traction deformity."  The underlying tissues called the SMAS may have been pulled more than the skin over it and the contour change started to appear as the swelling went away.  The treatment usually involves fat grafting to cover up the indented areas but can also include redraping the skin to smooth out the indent.  Best Wishes!!

Simona V. Pautler, MD · Answer

Your photo shows you smiling, I'm wondering if the dent is visible when your face is in repose. Nonetheless, 2 years is long enough for any scar tissue or tethering from subcutaneous tightening to soften and relax. The vast majority of issues like this resolve within the first year. it's hard to say what caused this without knowing what kind of work was done (ie SMAS or deep plane lift). At this point I would try using a hyaluronic acid filler (like restylane, juvederm, etc.) to see if the depression could be filled in. If the filler works, you could then try to do a fat grafting procedure for longer lasting correction.

Charles K. Lee, MD, FACS · Answer

The sunken area is probably a segment of skin that is still stuck to the underly SMAS that has not been fully released.   I would have to evaluate it more carefully in person and see how it moves with facial expressions, etc.  Most likely, a bit of volume with fat grafting may be able to help or it may require additional release of the skin to the SMAS.  Good luck!

Robert M. Wald, Jr., MD · Answer

Facial indentations can be improved using a filler or fat injections. This sunken area is due to facial atrophy. You can see this following a face lift and the repositioning of the underlying soft tissue. I would re consult with your plastic surgeon and discuss this issue.

Bruce B. Kadz, MD, FACS · Answer

Not sure what the reason is. You would have to ask your previous surgeon. You can potentially correct that and improve the overall appearance of your face and neck with another face and neck lift which involves repositioning of deep tissues (SMAS layers).

Sunken area 2 years after facelift - what could have caused this and can it be treated? (photos)

Answers (13)

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