Unhappy with results of my lower facelift - were my expectations unrealistic?

Dear Generous,

IYour expectation is not necessarily unrealistic, but it’s important to recognize that deep plane facelifts, while highly effective for midface and lower face rejuvenation, can leave some degree of skin descent or asymmetry due to factors such as skin elasticity, healing variability, and natural facial asymmetry.

Secondary facelifts can be a challenge and each surgeon will have his or her thoughts on improvement of your situation. The goal is improvement and not perfection. This is what I would consider:
1. Secondary Lift with Skin Re-elevation and SMAS Adjustment
2. CO2 Laser Resurfacing
3.Volume Correction with Fat Grafting or Filler, if necessary

Seek the opinion of your operating surgeon as well as additional plastic surgeons via an in-person consultation.

Best wishes

Earl Stephenson, Jr, MD, DDS, MBA
ESJ Aesthetics

You may benefit from some additional treatment for the peri-oral area just as an ablative erbium laser.

It is not unusual to suffer relapse in this area since it is the most mobile part of the face. Sometimes a small revision to address the jowl and nasolabial fold can nicely supplement the prior procedure and get you the results you were after. For example, in your case, a temporal cheek lift to lift the cheek, and tighten the jowl area can be done under local anesthesia to correct these stubborn areas.