2 months post mid-face lift, and I'm a bit disappointed with outcome. What are my options? (Photo)

Thank you for your question. I understand that you’ve undergone a mid-facelift in the past, and you’ve also had a history of Botox and IPL treatments in order to address some facial lines and other issues. However, now you’re dissatisfied with the appearance of the outer corners of your mouth or what you refer to as smoker’s lines.I can certainly help you with this as I perform a lot of cosmetic eyelid surgery, all types of facial implants, and surgical and non-surgical facelifts. I specialize in facial aging and have written a book about it. I am a Board-certified cosmetic surgeon, and a Fellowship-trained oculofacial plastic and reconstructive surgeon and have been in practice in Manhattan and Long Island for over 20 years.Looking at your photos, the lower part of your face and your neck does show improvement, but what I think has you concerned in the subsequent volume loss that happens with facial aging.During cosmetic surgery consultations, I always try to explain to my patients that with facelifting, we try to correct two specific elements of facial aging: descent and volume loss. Descent refers to the loss of support and sagging of the soft tissues of the face, the fat, and the SMAS (superficial muscular aponeurotic system), which is the layer of muscle that is lifted in a way that is appropriate for the patient. This also include the correction of sagging or prominent neck bands, which we do via a platysmaplasty. With volume loss on the other hand, there is a loss of soft tissue, bone, muscle and fat. To remedy this, I will often suggest the placement of facial implants as part of the treatment. For example, the little depression along the jawline, called the mandibular notch can become pronounced even after a facelift. Therefore, it is quite common to place a chin or pre-jowl implant in that area to smooth it out.Often, a patient is quite overwhelmed during consultation about how many possible facial implant options there are, so it is very important in our practice that the patient is aware of which areas specifically will need volume enhancement, and which won’t. This may have been an area where you and your doctor had a little miscommunication on.Keep in mind that a facelift restores the structure of the face, and cosmetic fillers (such as Restylane and Juvederm) restore volume. More recently, we’ve been performing what’s called the Y Lift® on a number of my facelift patients. The Y Lift® is a method that involves placing a long-lasting hyaluronic acid filler, like Juvederm or Voluma, into the much deeper structural levels of the face, under the muscle and near the bone. This method has been extremely helpful and effective in restoring volume to specific areas of the face, such as the cheeks, chin and jowl areas, after the patient has had a facelift. It is also not uncommon to combine a cosmetic filler to add lip volume, and to use laser treatment to improve the lines around the mouth. At this point, I think it’s important that you discuss with your surgeon the kind of strategy you want to pursue to address sagging and volume loss. I understand that you are concerned about cost, but keep in mind that maximally improving your face will require some type of maintenance down the line. Also, keep in mind that you may not necessarily need to have something drastic done. Often, outlining the lips and improving the cheeks and chin can make a wonderful difference. Another important point is with regard to swelling. Your face will still have a certain amount of swelling 2 months after the surgery, so you can expect more volume loss as the swelling settles.I hope that was helpful and I wish you the best of luck!This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Those lines at the corners of the mouth can be pretty stubborn, even though it looks like you had a good facelift done.  Lines around the mouth may need to be addressed with injectable or laser if you want further improvement.

A facelift will improve your jowls and lax facial skin on your cheeks (as it has done beautifully) It won't change the area around the mouth which is better treated with botox, dermal fillers, peels and/or CO2 laser resurfacing. The recovery from deep treatment with the later can be longer than a facelift if really effective results are to be achieved. Perhaps discuss this with your facelift surgeon as I would hate for any patient to continue to be disappointed in an area when there are good treatments available. Good luck.