Had facelift in 2011. 3 attempts to correct some issues. Smile is awful. Stretched mouth, drooping corners. Advice?

Hello,This is a difficult issue to treat and, as you've experienced, is unlikely to be fixed with fillers or other injectables. The solution most likely to solve the extended mouth corners is a procedure performed for macrosomia. This is often done in children with this abnormality associated with clefts of the face. Your best bet is likely to find a surgeon in your area with experience as a craniofacial surgeon (someone specialized in cleft lip/palate and other craniofacial anomalies) and he/she will be knowledgeable about this procedure and can discuss the risks/benefits with you. All the best, Dr. BlaggAustin, TX

Thank you for your pictures and questions.  Sorry you have not been through a smooth journey.  The risk of correction surgery is their is always a change of it looking worst than before, which then sets you back even more than before.  I would suggest leaving everything to settle for a while until trying to correct again.  Please ensure the consultations you have with a surgeon are repeated, making sure they are 95% they can make an improvement.  The corners of the mouth could be addressed by a valentine lip lift.  I hope you find the treatment that is right for you and please remember to find a board certified surgeon.. Good luck!

The "joker smile" after a facelift is usually caused by pulling too much laterally, or backwards, and not enough upward. This is usually due to a lack of release and the surgeon feels that pulling backwards is the only direction that moves. This pulls on the mouth and gives an unnatural look. The good news is that this usually improves over many years. If fillers and fat failed, a couple of possible solutions are still available. One would be a commissure plasty where a triangle of skin is resected along the corner of the mouth and the closure lifts the corners. The downside is that the scar can frequently be very difficult to camouflage. The other possible solution is a revision facelift. I have seen many patients that had a look of a facelift and a revision facelift using the deep plane technique where the zygomatic ligament is released and the midface is elevated with the lower face can lift the corner of the mouth and improve the look of a prior facelift. This is a more advanced form of facelift, so see someone with extensive experience with this technique. Personally, I would try additional filler again. It may take several treatments spaced one to two months apart to get the result you desire.Andrew Campbell, M.D.Facial Plastic SpecialistQuintessa Aesthetic Centers

Any flaws or shortcomings following previous surgery can be improved. You may want to have an in person of virtual consultation with one of us who specializes in the plastic surgery of face with sufficient experience to help you properly.

Thanks for sharing your photos. Correction surgery for undesirable results after a facelift procedure has always had its risks in getting an even worse outcome. This is a fairly complex problem to treat. Based on your photos, it is perhaps not possible to get it fixed with injectable fillers. As mentioned in the question, your concern with a stretched mouth and droopy corners can be addressed with a surgical procedure that is primarily done for macrosomia in children with congenital clefts of the face. A craniofacial surgeon can better advise you on your viable treatment options and likely outcomes. I hope this helps.

After multiple procedures to correct an area of concern, such as the corners of your mouth, you should remain cautious and proceed only after you have received multiple consultations.  
Although facial surgery remains an option nonsurgical procedures may offer you benefit.  Strategically placed fillers into the corners of your mouth, by a skilled injector, can improve these areas.  In a rare individual a corner of the mouth lift may improve your downturned corners.  You trade a small incision for this procedure that should be undetectable when fully healed. 

The downturn at the corners of your smile can usually be improved with filler and botox to relax the depressor muscles below. In my experience, there is not a good surgical solution to fix that problem because of the scars. Best of luck and dont be so hard on yourself!

look at the article I did in the plastic surgery journal on my website. The answer to your issues is not more surgery which will make you look worse.more pull means more distortion. The answer is to fill in the depressed areas. It will probably take 4 cc of filler like restylane to start looking better. Fat has issues because of its unpredictability. Avoid surgery.