SMAS facelift and vertical forehead lift 2 years ago - How do I lift the saggy midface?

Question

I had a Smas and vertical forehead lift 2 years ago. It didnt address my main concern, though. I hate my sagging, downturned mouth and midface. How to fix this?

Ali Sajjadian, MD, FACS · Answer

Thanks sdnatvbb for your question! A consultation with a Board-Certified Plastic Surgeon is necessary to determine the appropriate options for addressing issues after an initial procedure.
One of the options for lifting the midface and corners of the mouth includs Revision Facelift (SMAS) in which a surgeon may choose to repeat or revise a SMAS lift to tighten and reposition tissues that were not sufficiently lifted previously. Another option is Deep Plane Facelift that unlike other facelifts, a deep plane lift operates beneath the SMAS layer, which may provide a more substantial and long-lasting repositioning of the sagging midface and mouth corners. Finally, Mouth Corner Lift (Anguloplasty) is a targeted procedure specifically addresses downturned mouth corners. However, it requires a carefully placed incision along the border of the lip to minimize visible scarring.
Non-surgical options, such as dermal fillers, can provide a subtle, temporary correction by adding volume to the cheeks and mouth area.
Understanding the limitations of any facial procedure is important. Visible outcomes are subject to individual factors like anatomy and tissue type. Every surgical or non-surgical intervention carries inherent risks, such as infection, hematoma, adverse reactions, or results that do not meet expectations. Only a qualified medical professional can evaluate your situation and provide personalized recommendations.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Kadir Berat Oyur, MD · Answer

It is quite common for a standard SMAS facelift and forehead lift to leave the central midface and the corners of the mouth unaddressed, as their lifting vectors primarily target the jawline, cheeks, and upper face. Based on your concerns , effectively lifting a sagging midface and correcting a downturned mouth typically requires a targeted deep-plane midface lift or an endoscopic lifting approach to elevate the malar fat pad vertically, often combined with a corner lip lift or strategic dermal fillers to turn the mouth corners upward. An in-person consultation with a board-certified plastic surgeon is essential to evaluate your previous surgical anatomy and determine the most effective secondary procedure for your goals.

Javier Parada, MD · Answer

Thank you for sharing your concerns. Based on your description, it sounds like your previous SMAS facelift improved some areas but did not fully address the deeper midface descent and support around the mouth.A deep plane facelift is often more effective for lifting the midface and improving the downturned mouth area because it repositions the deeper facial tissues rather than only tightening the skin or SMAS layer. This technique can provide a more natural improvement in the cheeks, nasolabial folds, and corners of the mouth.Depending on your anatomy, additional treatments such as fat grafting or a corner lip lift may also help optimize the result.A detailed evaluation would be necessary to determine the best revision approach based on your prior surgery and current anatomy.

Don W. Griffin, MD · Answer

Based on your pictures after your SMAS facelift, you have heavier tissues with downturned mouth and laxity around the mouth and lower medial cheeks. Neuromodulator injections into your DAO muscles can help with elevating the corners of your mouth, as can differing variations of a lip lift, but only a revision facelift procedure will address all of your concerns.

Gary M. Horndeski, MD · Answer

You may benefit from a repeat facelift to take care of the cheek and jowl areas. However, a more minor alternative to consider would be an eccentric lip lift, not a bullhorn 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.

Semih Yildiz, MD, FEPOBRAS · Answer

At two years, swelling is no longer the main issue, so I would treat this as revision planning. A SMAS facelift and forehead lift do not always correct the central midface or mouth-corner descent; those areas may need a different lifting vector, volume restoration, or targeted treatment around the marionette/DAO region.
I would assess cheek support, nasolabial fold and marionette depth, skin quality, prior scar pattern, and whether the concern is laxity versus volume loss. Depending on the exam, options may include revision lower face or midface lifting, conservative fat grafting or filler, or smaller nonsurgical refinements.

Carlos Alberto Ríos García, MD · Answer

From your photo, it does appear that your main concern is centered more around:
* midface descent* lower facial heaviness* and downturn at the corners of the mouth
rather than the upper face.
One important thing many patients discover after facelift surgery is that not all facelifts improve the midface equally. Some techniques primarily target:
* the jawline* neck* and lateral facial tissues
while the central cheek and perioral area may remain relatively unchanged.
That is likely why you still feel bothered by:
* the nasolabial area* mouth downturn* and heaviness around the lower midface
even after a SMAS lift and forehead procedure.
The challenge is that the area around the mouth is one of the hardest parts of facial aging to fully correct surgically because:
* facial movement is constant* tissues are heavy centrally* and volume loss often contributes in addition to skin descent
Depending on your anatomy and what was previously done, improvement may sometimes involve:
* midface-focused lifting techniques* deep plane revision approaches* volume restoration/fat grafting* corner-of-mouth support* skin resurfacing* or combinations of these
The good news is that your overall skin quality still appears relatively good, and this does not look like a failed facelift as much as a procedure that may not have fully targeted the area that bothered you most.
Revision facial surgery requires very careful evaluation because previous lifting changes the tissue planes and scar patterns underneath. In these cases, the goal is usually refinement and repositioning rather than simply “pulling tighter.”

Thomas A. Mustoe, MD, FACS · Answer

The midface including cheeks and areas around the mouth are the most difficult areas to correct with a facelift. The superficial muscle layer (SMAS) relaxes with age  just as the skin relaxes but to optimally restore the SMAS to its more youthful position the anchoring points nor retaining ligaments that extend down close to the moth need to be released to actually reposition the SMAS rather just pulling in it. The SMAS is too thin to lift it thoroughly closer to the mouth. In a deep plane facelift optimally performed, the skim and SMAS are left as a composite allowing a more complete release and repositioning. The extent of the release depends on the surgeon and not all deep plane facelifts are equivalent.

Yily De Los Santos, MD · Answer

The mouth area and midface can be some of the most difficult areas to fully correct, even after a SMAS facelift, because not all facelift techniques address the face with the same vector or focus.

Many facelifts improve the jawline and neck very well, but descent around the mouth, nasolabial folds, and midface often require a more vertical lift and deeper support through the cheek area.

It’s also important to determine whether the main issue is true sagging versus volume and structural loss, because that completely changes the treatment approach. In some patients, the face appears “droopy” more from loss of support than excess skin.

Depending on your anatomy and how your previous surgery healed, options may include:
— Revision facelift focused on the midface
— More vertical cheek elevation
— Fat grafting for support and smoother transitions
— Refinements around the corners of the mouth or jawline

Ronald J. Edelson, MD · Answer

I notice that you still have prominent sagging of your jowls. You may benefit from a second mini lift to address that area and tighten the jawline

SMAS facelift and vertical forehead lift 2 years ago - How do I lift the saggy midface?

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