What is causing this tethering/dent and how can I fix it? It’s worse when smiling, especially along the jaw. (Photos)

Question

50, female, 144, 5’6”

Ali Riza Öreroglu, MD · Answer

When evaluating tethering or contour irregularities like this, it is important to look at the face as a whole rather than focusing on a single area. A definitive treatment plan cannot be made from photos alone; an in-person examination is necessary to assess skin quality, tissue laxity, volume loss, and the underlying facial anatomy.
If there is evidence of facial sagging and volume deficiency, a lower facelift combined with fat grafting may provide a more balanced and natural improvement. For specific surface irregularities or tethered areas that become more noticeable with facial movement, dermabrasion may also be considered in selected cases.
The best results are usually achieved by addressing the overall facial structure, volume distribution, and soft tissue dynamics rather than treating only one isolated area.

Semih Yildiz, MD, FEBOPRAS · Answer

The photos show a small lower-cheek/jawline indentation that appears more noticeable with smiling. When a dent worsens with animation, possible causes include scar tethering or adhesion, uneven subcutaneous fat, skin laxity, or pull from the muscles around the mouth and platysma; the exact cause cannot be diagnosed from photos alone.

The right fix depends on what moves and what is fixed during an exam. If it is scar tethering, careful release or subcision with small-volume fat grafting or filler may help; if muscle pull is contributing, a conservative neuromodulator plan may be considered. A facial plastic or plastic surgeon should examine you smiling and at rest before choosing a treatment.

Kamol Pansritum, MD · Answer

Based on your photos, the tethering and denting along the jawline may be related to a combination of skin/tissue laxity and scar tissue or fibrous adhesions. This can become more noticeable when smiling as the facial tissues move. I would recommend a full facelift, with or without a neck lift, for a more predictable correction.

What is causing this tethering/dent and how can I fix it? It’s worse when smiling, especially along the jaw. (Photos)

Answers (3)

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