Sad Face, Puffy Pads, Loose Neck Skin, Alternative to Botox & Fillers? (photo)

Full face lift age 48 1996 best thing I ever did, totally stopped aging process and I looked about the same then as I do now BEFORE procedure except 16 years later time marches on: gained & lost weight; didn't do any skin maintenance, no fillers or botox. Now developing turkey neck and I see lines & fat pads on either side of mouth along with downturn corners making me look sad or mad. Will cheek lift or lower facelift resolve this as no surgeon in area does lip lift which won't address neck

Doctor Answers 14

Faces and gravity

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Your photos show that you may benefit from a secondary facelift.  Plastic surgery can slow down the aging process, but time still marches on!  This facelift will be the “second best thing” you’ve ever done!


Lifting procedure

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It appears that after this time that you have developed the natural or normal sign of aging which includes both volume loss as well as looseness of the skin which is resulting in the combination of downward appearance of your lips as well as the extra skin under the neck. In my experience, it is generally recommended that you would have another lifting procedure to restore the relationships of the skin on the neck and the cheeks to the more superior position or where they originally were. At that point any type of volume enhancement such as the use of fillers as well as doing a lip lift with filler and Botox can be considered and  but would be more effective.

Sad Face, Puffy Pads, Loose Neck Skin, Alternative to Botox & Fillers? (photo)

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You are a great candidate for a second facelift and neck lift. There are some beautiful techniques that I have learned using filler to turn the corners of the mouth upward and make them look more rejuvenated. You could also benefit from some volume in your lips for overall balance in the rejuvenation process. There is a strong movement back towards fat grafting in conjunction with a facelift. Find a board certified surgeon who is comfortable with that technique. Most patients need an additional session of touch up fat grafting but can have long lasting results. Neurotoxin injections such as Botox or Dysport into the muscles of the lower mouth corners can also help turn the corners upward and rejuvenate them. You can have the best facelift in the world but if you do not take care of your skin your results will not last. Talk to a skin specialist and start using some of the great products out there. A retinoid product is a must!

Sad face and loose neck

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Thank you for the helpful photos.

You should get an excellent result with a redo lower face and neck lift.

A cheek lift can be done at the same time.

I do not see Botox or fillers helping much.

Consider starting therapeutic skin care (tretinoin+glycolic+hydroquinone) to maintain the result since the Florida sun has probably helped to thin your skin. Best wishes.

How to treat "turkey neck" and downturned corners of the mouth?

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A second facelift is the best option to tighten your neck and reduce the lines below the mouth. I would actually recommend Botox to the DAOs (below the corners of the mouth) and filler to lift the corners of your mouth and slightly augment your lips. This should be conservative and maintain the balance between the upper and lower lips but should be effective. I hope this is helpful.

Stephen Weber MD, FACS

Platysmaplasty and Facelift

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There are many options here, but a facelift with SMAS plication with platysmaplasty will produce excellent results.  Kenneth Hughes, MD Los Angeles, CA

Lower facelift to address turkey neck

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Facial laxity, jowls, and turkey neck are all addressed through a face/neck lift.  The incisions from the previous facelift are also removed at the same time.  Facial laxity, jowls, excess neck skin, and anterior platysmal bands are all addressed during the facelift procedure.  This will improve the face/jaw neck angle.

No plastic surgery lasts forever

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By which I mean that the improvements that you see after your surgery will proceed to age as well as the rest of your skin and body. What I try to explain to my patients is that the less you do, the less result and permanence, so you must decide for your self how much improvement you are willing to settle for versus how much surgery, downtime and so forth you are willing to trade in exchange.  Discuss with your board certified plastic surgeon what bothers you and how to correct it either totally or just a bit and then decide on your course of action.  Good luck!

Eleanor J. Barone, MD
Tampa Plastic Surgeon

Droopy face, sagging neck, and facelift

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Your photos are very helpful. You would be a good candidate for a secondary facelift. In addition to a facelift I would add fat grafting +/- PRP in order to restore volume in the checks. The addition of volume in the cheeks will give you a very natural, youthful look by adding a third dimension to your face that surgical pulling cannot accomplish.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Sad Face, Puffy Pads, Loose Neck Skin, Alternative to Botox & Fillers?

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Thanks for the posted photos. In my opinion a secondary face/neck lift with fat graft+PRP injections is the choice. Also a lip lift if wanted can be done. Seek more in person opinions. 

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.