Face laxity after a lower facelift. Do I need a revision? (Photos)

Question

i had a lower facelift on march 14 and am noticing what looks like jowls coming back ? i also had a fat transfer . i do have a thinner face but i do not know if i need a revision or some sort of filler . i see a little picket of loose skin near mouth suggestions ?

Thomas A. Mustoe, MD, FACS · Answer

The extent of correction around the mouth is partially dependent on technique and unfortunately the skin and to a lesser extent the underlying superficial muscle layer stretch in response to tension (an intrinsic biomechanical property affected by patients genetic makeup and age) .  Filler or fat transfer will not substantially fix the problem without adding so much volume that it changes your facial shape. A secondary deep plane midface lift would give a major correction without looking tight or pulled. The superficial muscle layer must be released and elevated for a natural and lasting g result.

Hasan Duygulu, MD · Answer

Because of labiomandibular folding a revision facelift can be considered but no neccesary.Fat grafting over marionet and perioral peel , or endolift tightening lasers or other resurfacinf procedures will fix the problem

Jeffrey Lisiecki, MD · Answer

This may be two things--either your facelift didn't release the ligaments and tighten the skin in this area sufficiently (especially if you had a deep plane facelift, which misses these ligaments where they attach to the skin), or your surgeon didn't restore enough/any volume in the prejowl sulcus, or a combination of both of these things.  Speak to your surgeon, or seek a consultation elsewhere if you'd like another opinion.

Gary M. Horndeski, MD · Answer

I recommend an eccentric lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Jeffrey H. Spiegel, MD · Answer

A lower face lift (e.g. necklift) can often not really treat the jowls. The jowls are part of the midface. To address those we need to go above where a "lower" lift is usually done. There are some minimally invasive approached that may be able to help if you are not ready for an additional procedure.

Michelle Zweifler, MD · Answer

Six months after a facelift, the postoperative swelling has subsided.  Patients may notice fine lines or wrinkles and it is not uncommon to benefit from some fillers  to address residual wrinkles.  Would also recommend going back to one's surgeon and seeing if a candidate for an revision.

Zoran Potparic, MD · Answer

It is too early to consider this result permanent; it usually takes good 12 months for result to mature in your age group. Without ability to compare your current photos with preoperative images it would be difficult to comment and give you any advice at this point. Patience. Good luck.

Yucel Sarialtin, MD · Answer

Hello, and thank you for sharing your concerns and photos.
After a lower facelift combined with fat transfer, it is common for patients&mdash;especially those with thinner faces&mdash;to notice subtle recurrence of jowls or minor skin laxity within the first year. A few points to consider:
Natural aging and skin elasticity: Even after a well-performed facelift, thin skin may show minor sagging or folds as collagen and elastin continue to remodel.
Fat transfer settling: Some areas may lose initial volume, which can make skin appear slightly looser.
Minor residual laxity: Small “pockets” of loose skin near the mouth can sometimes be addressed non-surgically.
In many cases, revision surgery is not immediately necessary. Non-invasive options such as injectable fillers, laser skin tightening, or microneedling can improve contour and smooth small irregularities. However, a thorough in-person evaluation is essential to determine whether a minor revision or touch-up procedure would provide a more lasting improvement.
The key is to balance natural appearance, facial harmony, and patient expectations rather than rushing into surgery.
Warm regards,Op. Dr. Yücel Sarıaltın, MDPlastic, Reconstructive & Aesthetic SurgeonIstanbul, Turkey

C. Carson Huynh, MD, DMD, FACS · Answer

Hello. Your jowls after a recent facelift is most likely resulted from inadequate deep plane dissection to reach the jowling area to lift up the jowl fat. A revision deep plane facelift if best option to correct this. You can try treatment with Morpheus 8 and FaceTite to “melt” the jowl fat and get some skin contraction to see if it can improve appearance without surgery.

Darryl J. Blinski, MD · Answer

Based on your nice series of photos, I recommend virtual consultations for better discussion points. I recommend revision a full mini neck facelift with re muscle plication and possible nano fat grafting under ultrasound. Expect possible fees in the $10,000 range. I might also add Endo laser treatment. Again, best of virtual consult with.