You are a beautiful woman, but that just makes it easier for me to make you gorgeous. Your eyes are pretty but they are surrounded by so little soft tissue that I can almost see the hollows of your skull. Fat transfer all around your eyes would correct that, but it might have to be done twice to make them absolutely gorgeous as the upper lid crease is way too deep especially medially (nose side) and less of the transferred fat lives in areas that move a lot. The wrinkles around your mouth can be corrected with fat transfer to your lips and around your mouth but you should wait for the Juvederm to dissolve. Fat transfer to your temples and upper cheeks will add soft tissue to soften the drop around your beautiful cheek bones. Your nose is best corrected with a composite graft from your ear of a tiny piece of cartilage and skin sewn to the inner aspect of your nostril where it is retracted upwards.
Okay, slow down. You have had 3 procedures that you are not happy with. I wouldn't jump into another surgery right now. I agree with your critiques but I still think your aging changes are mild. You look thin and have some volume loss. I would start with a conservative procedure such as fat grafting. That can address several of your issues in moderation. It is also a way to get to know your surgeon and gain trust. Discuss further with your surgeon. Good luck!
Face lift and ckeek implant
Looking at your limited pictures, I would recommend a mini or lower face lift with a submalar cheek implant and not necessarily a chin implant. You definitely need more midface volume and a conservative mini or even MACS lift can bring the face into a nice balance. I believe you would also benefit from a fractional CO2 peel and routine skin care to improve skin texture and pigmentation. As you have seen, soft tissue fillers and fat grafting are extremely operator dependent and asymmetry and contour irregularities are not uncommon. A conservative mini lift and submalar cheek implants will likely rejuvenate your face nicely with minimal down time and risk in the hands of a well trained surgeon specializing in facial rejuvenation
I would start with a conservative approach to address your areas of concern and then take it from there. I would recommend a personalized consultation in person as your concerns would be better addressed with a more customized evaluation.
Facial rejuvenation with fat transfer
I can not agree that face/midface lift is a good choice for you. I would consider to use fat trasnfer, AFG to restore voulme on midface, filling smile line, use of chin implant to improve your facial profile, revision of rhinoplasty and using Botox to improve the lip's corner position ( to raise the corner of upper lip)
Fourties seeking face lift
I have performed Face Lifts for over 20 years and IMHO, from your photos: the cheeks are a bit angular and could be more soft and rounded which make the face appear soft, feminie and youthful. The nasolabial folds display excess subcutaneous fat which appears more on the right than the left. There is evidence of jowls on both sides and excess skin. The chin appears a bit weak and there is excess skin and fatty tissue under the chin.
IMHO a minimum incision Face Lift with proper aesthetic shaping, of the cheeks, using Perlane, Radiesse or Cheek Implants combined with reduction of the nasolabial folds, anatomical chin implant (size small) with excision of exces skin and micro-lipo under the chin would do the trick. Would take about 90 minutes, with or without general anesthesia. Patients are allowed to fly home in as little as 3 days.
I do not perform nor recommend the mid face lift as it causes distortion of the corners of the mouth and eyebrows due to the vector of tissue pull, IMHO.
It appears that you may have had a previous Rhinoplasty with removal of a dorsal hump that has resulted in an open roof deformity and wide nasal bridge. There are some irregularities of the nasal tip and nostrils as well. All, or part, of these can be addressed with a closed Revision Rhinoplasty. Hope this helps.
Facial Rejuvenation with fat Injections, Chin Augmentation and Revisional Rhinoplasty
The issues that you have around your mouth are not correctable by any form of facelifting procedure, albeit a midface or lower facelift. You simply don't have enough of skin sagging to justify such efforts. The use of injectable fillers or fat grafting for some mild volume restoration could prove helpful however. Your chin is mildly deficient in the one side view and a small chin implant may be beneficial but it would be helpful to see some predictive computer imaging beforehand. Your nose does have some adverse changes that a revisional rhinoplasty may likewise improve including a pinched tip deformity and excessive nostril show. The combination of chin augmentation, fat injections and revisional rhinoplasty are a collection of individual mild changes that can create together an overall rejuvenated look that still appears natural.
Those lines by your mouth and upper lip will not be fixed by any implant, mid face or lower neck lift. Mini lifts can improve the jawline but I don't think you have enough laxity there yet to justify the degree of invasiveness of the procedure. I would stick to fillers here. Your nose is to short and over rotated for your face. It makes the middle third out of balance with the upper and lower thirds and exaggerates the length of the skin of your upper lip. It is also rounded on the tip which does not match the angularity of your facial bones. I would recommend you see someone with experience in rhinoplasty revision if you are unhappy with this.
Facelift vs cheeklift and rhinoplasty revision for unatural nose.
You have many issues and I would like better photos. I don't think you are a mid facelift candidate. The excess skin and muscle of your face and neck can be improved with a facelift and fillers. Your nose surgery is not natural. The tip is pinched, the nostrils retracted, etc. These can be improved by grafting your septal cartilage to the areas where too much has been removed and lengthening your short nose to give less nostril show.
Mid-facelift, or lower facelift
In your early forties, for some a soft or mini-facelift can make sense to improve the jawline and early jowl, and also will allow filling of cheek hollows. However without any of these issues lower facelift is out of the picture, and with a fairly high cheek so is a mid-facelift. We would suggest sticking with injectables, or consider structural facial fat grafting to improve facial shape. Chin implants as well have a very strong impact on facial shape and appearance and in your forties would be on our caution list.
Best of luck,