Sagging of the neck 11 months after SMAS facelift (includes the lateral face and jawline) (photo)

Sagging neck and jowls one year after full facelift is not normal for experienced facelift surgeons. I would discuss this with your surgeon and if you do not have confidence in his ability to correct this I would get a second opinion from a very experienced facelift surgeon.   

I'm not sure specifically what type of operation you had based in your description. In general a full facelift includes the neck and one expects a very good result. It looks as though you would benefit from a revision of the lower facelift.

As a cosmetic oculofacial plastic surgeon, it is possible
that patients can have jowls, marionette lines as well as sagging neck skin
after a facelift, which primarily depends on their genetics. Without the
benefit of a physical examination and the full details of the actual procedure
performed, it is difficult to assess if this is outside the norm.



The terminologies of a mid-face suspension and a superficial
muscular aponeurotic system or SMAS lift can mean different things to different
surgeons when they are implemented. Clearly, I would suspect that when you
chose your doctor, you had done your research and you felt comfortable with
your doctor’s ability to perform this procedure. It is understandable that you
are concerned if you are not seeing the results.



Within the spectrum of facial cosmetic surgery, I will tell
you from 20 years of that certain factors have an impact beyond the immediate
post-operative period. If you noticed immediately after surgery that your face
and jawline looked very good, sometimes it’s not just about the amount of lift,
but also the degree of swelling that has a factor in this process. Sometimes,
people look a lot better while there’s a little bit of swelling in the
mid-facial area while they’re healing.



If the jawline looked good then it has descended, then we can
probably conclude that there’s a certain degree of regression. That regression
can be from skin elasticity or tissue elasticity that’s deeper or it can be
from a variety of factors. I always explain to my patients that even though I
can do a meticulous procedure and do some really good tightening, the human
body can still change. If someone has a lot of volume and sagging under their
chin then this degree of residual may still be expected. If someone didn’t have
as much, then it would be unusual.



I think it is important that you maintain communication with
your doctor and discuss these concerns. Most ethical cosmetic surgeons are
willing to do any enhancements as indicated in the terms you agreed upon before
surgery. Unfortunately, there are doctors who will tell people that they look
fine even though they don’t look and feel fine. It is your call to decide
whether or not you’re going to seek additional opinions. From my perspective,
it is often best that you see the original doctor, who must be good and caring and
technically skilled. They know your anatomy and they’re most likely comfortable
with doing any revisional surgery. If you’re not satisfied for any reason, then
get any additional opinions. I hope that was helpful, I wish you the best of
luck, and thank you for your question.

It would be helpful to compare your before and after pictures. From the pictures that you have provided, it appears that you have some residual laxity in the jowls and the neck as well as some contour irregularity in the neck. As has been previously stated, I would sit down with your surgeon and discuss your concerns and see if a revision surgery would be appropriate.

Some patients do get residual rebound laxity, and need a revision or touch-up within a year.  It happens to the best surgeons too.