Sagging skin returned after facelift. Is that normal after one year? (Photo)

Question

I had a full face life 11/22. I’m very happy with my neck but my jowls and sagging cheeks came back. Is that normal after one year. I’m a 50 year old female. I weigh the same as the day of the surgery.

Stefan Mark Szczerba, MD · Answer

I think this comes down to three reasons:
1. not releasing the ligament known as the mandibular cutaneous ligament that is in front of the jowl- if you don't release it, the lateral pull of the facelift cannot keep a more youthful position over time.  Not every surgeon feels comfortable with this, so do not be too hard on your surgeon!  There is a nerve that lives deep in the area that he or she was likely trying to avoid,
2. soft tissue fullness of the jowl area sometime just needs direct treatment with gentle liposuction (or direct excision with scissors) during the facelift procedure.
3. vertical vector pull of the facelift holds a more youthful position than lateral pull.  Getting a vertical pull may require a deep plane facelift approach that some plastic surgeons do not offer because it is a bit more invasive.

Have a sit down with your plastic surgeon.  Most board certified plastic surgeons can help you through early recurrence of aging changes after a facelift.  Best Wishes!!

Farid Brad Mozaffari, MD · Answer

Hello. Facelift results should last you much longer than one year. In rare instances, tissue can loosen quickly after surgery, but that more than likely would have also affected your neck also. There are many reasons why this could have happened. I would suggest that you see your surgeon that did the operation to discuss this and try to find a solution.

Jacob Tower, MD · Answer

Hello, hope you are well. It is not normal per se, but it certainly can happen as evidenced by your experience. The durability of the results will depend on individual factors that are unique to you as well as the surgical technique. If you are not satisfied with these results you can consider revision surgery, or minimally invasive procedures designed to tighten the skin/soft tissue envelope. 
Best,Dr. Tower

Mats Hagstrom, MD (license on probation) · Answer

The answer to your question will vary substantially based on a multitude of variables.
The longevity of facelift varies based on each individuals candidacy for the procedure in the first place, and by how the procedure was performed.
Plastic surgery outcomes are generally always based on those two single variables.
Patient candidacy and still an experience of the provider.
Patient candidacy for quality facelift outcomes is fairly complex.
Premature facial aging is highly dependent on facial bone structure.
Individuals who don’t have the skeletal foundation necessary for ideal facial aesthetics are more prone to showing premature facial aging.
This includes premature jowls, loss of jawline definition, the formation of a double chin, and deepening of labiomental folds.
The type of facelift surgery also has a substantially impact on the quality of the outcome and longevity of results.
Plastic surgeons will have different opinions on how facelift should be done.
My personal view is that quality SMAS suspension is an integral part of equality facelift.
Other plastic surgeons are less focused on proper SMAS suspension and focused instead on a deep plane Skin and subcutaneous tissue type facelift. The degree of soft tissue undermining can also have a great impact on the longevity and quality outcomes.
It’s a fairly complex topic, and there are no simple yes or no black or white answers to your question.
In the end there isn’t all that much. Patience can do regarding their own candidacy.
What patients do you have control over? Is provider selection.
Finding the right plastic surgeon for a procedure is not at all easy or straightforward.
Unfortunately the search process and would most people refer to as “doing their homework” tends to be highly manipulated by individual providers and clinics successful ability at manipulating online presence.
In fact, online presents is probably more inversely correlated to plastic surgery skills than the other way around.
The most successful and talented plastic surgeons typically don’t need to promote their practice and those who put strong emphasis on advertising and self promotion probably are doing a better job at trying to make money than they are taking care of patients.
To find the best provider, I generally suggest the following.
Start by making a list of plastic surgeons in your community who seem to have a strong track record for the procedure you’re interested in.
Look for plastic surgeons, who have preferably one to two decades of experience.
 Next schedule multiple in person, consultations with the plastic surgeons who seem to have a strong reputation for the procedure you’re interested in.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients, who had similar characteristics to your own.
 Bring pictures of yourself the same way plastic surgeons take before and after pictures and use those pictures as reference during the consultation, especially when reviewing before, and after pictures.
Being shown a handful of pre-selected images, representing the best results of a providers career may be insufficient to get a clear understanding of what average results look like in the hands of each provider, what your results are likely to look like or how many of these procedures that surgeon has actually done.
 There is no correct number of consultations needed to find the right provider.
Sometimes it is simply a matter of luck.
Considering how much variation there is among plastic surgeons I suggest patient start the process by having five or six consultations.
The more consultations you scheduled the more likely you are to find the right provider for your needs.
The biggest mistake. Patient make is scheduling only one consultation and then scheduling surgery.
Scheduling only one consultation, more or less eliminates the ability to choose the better provider.
 I generally recommend people avoid virtual consultations whenever possible and schedule in person consultations with local providers when possible.
I generally recommend people avoid traveling long distances for elective surgical procedures, if at all possible.
I recommend patient avoid seeking out famous plastic surgeons, plastic surgeons, who have excessive media exposure, and those who have a strong emphasis on self promotion.
These are not the traits of quality physicians.
These are the traits of successful business people and self promoters. 
Recognize that, finding the right plastic surgeon is inherently a complex and difficult task that most patients actually do quite poorly.
Best,
Mats Hagstrom, MD

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