Neck & mid-facelift 4 months ago (healed fast), I have sagging on right side of my face. Can it be pulled tighter up? (Photos)

This top dollar surgery improved my jawline. But as for midface, I look worse: I am sagging on the right side of my face from the upper cheek down to my lower face: upper lip creases, side of lip frowns, lower cheek pooches out, and lower eyelid slightly droops. Can this be re-lifted? When I pull up on the muscle at the incision place (just below the temple in the hair), all issues rectify. Surgeon says use botox, filler or laser to fix it, but I want another lift, so it that possible?

Doctor Answers 16

Improving outcomes

After facelift, it is difficult to compare your results by pulling your skin with your fingers up to your hair, as you describe.  This is because no matter how hard we pull on the inside, there will always be some skin laxity and slide on the outside.  There are several layers to the skin and tissues of the face, and you need this laxity for facial expression, speaking, chewing and breathing.

That said, there is always a possibility to improve an unsatisfactory result.  It is possible that your surgeon was not able to get correction at the corner of your mouth for multiple reasons - unfortunately "top dollar" doesn't mean anything about the actual technique that was used.  

If you desire another operation I would ask 2 questions:

1.  When is the appropriate time (I would wait at least 6months-1 year minimum)

2.  How will the surgeon correct the problem (do something different? do the same technique, just tighter?)

Hope that helps,

Christopher C. Chang, MD 

Washington DC, Maryland, and Virginia

Slight droop after facelift

Thank you for your question and photos. You had a neck lift and midface lift and there are many ways to do this. Good to hear your jawline looks good. Midface lift is supposed to lift up the cheek to a more youthful position. The face should be reasonably symmetric after the surgery (not perfectly symmetric as everyone has some level of facial asymmetry). If there is noticeable asymmetry then you can think about a touch up procedure. Keep in mind however, that generally speaking a facelift does not improve the area around the mouth to the same extent as the jawline, neck and upper cheek. This is why volume needs to be added the face with the facelift to help restore what is lost with aging. Certainly get a second opinion to gauge what other surgeons can offer if you feel you need more information.

Jeffrey Jumaily, MD
Toronto Facial Plastic Surgeon
5.0 out of 5 stars 10 reviews

Revision of Mid Face Lift

Terminology differs however mid face lift to me means that less may have been done than could be accomplished with a true facelift.  Incisions may be more extensive but can be camouflaged well.  Discuss options with your surgeon and if not satisfied, consider reviewing your operative report with other bd certified surgeons to get opinions based on the details of your operative note and what potential exists for further improvement.  Good luck

Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
ABC-TV Extreme Makeover Surgeon
Beverly Hills, California

Jon A. Perlman, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 30 reviews

Jowling after 'Mid face' lift

Hello,

It is unlikely filler or laser will help that area, and I can't imagine how Botox would even be employed. Minor touch ups are common in facial surgery. If your surgeon doesn't want to do it, someone else will.  Best of luck!

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Unhappy with mid-face lift - didn't hold up

Thank you for asking about your face lift and mid-face lift.

  • This is something you need to discuss with your surgeon
  • One would need a face to face examination, review of before/after photos and the operative report to know if your surgeon's recommendations are right or if further surgery is needed.
  • If your lower lid has drooped slightly, then it suggests further lifting may not be a good idea as it may pull the lower lid down even further.

Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Lifting vs Filling

Dear Cassietown,

Thank you for your question.  The area that you are noting is well addressed in the treatment of the midface.  Unfortunately, without being able to see the rest of your face it is hard to determine where the challenge and where the missed opportunity exists.  Commonly as we get older we lose skin elasticity as well as facial volume.  Procedures that you mentioned to lift the facial tissues to their previous alignment, but do nothing to address volume loss.  Given the details that you mentioned, and without having further information such as photographs to draw from, I feel that not addressing your facial volume in the midface may be the main culprit.  This is well evidenced by the slight elevation near your temporal tuft of hair and the immediate remedy of your concern.  I hope this helps you find the best answer for you.

Be healthy and be well,

James M. Ridgway, M.D., FACS

James M. Ridgway, MD, FACS
Bellevue Facial Plastic Surgeon
5.0 out of 5 stars 78 reviews

Midfacelift/ neck lift

yes returning to surgery may be the best answer. asymmetries with midfacelifts are not rare as they frequently are done with internal sutures after freeing of the deep tissues without removal of skin, which can be done symmetrically more easily than without skin removal.  

Revision facelift possible

Since your initial surgeon has recommended a non-surgical solution and this doesn't seem to be your first choice, I would advise you to get a copy of your operative report and schedule a consultation with a board certified plastic surgeon in your area to discuss revision options. It may be that the results that you desired weren't possible with only a mid-facelift. 

Kindly,

Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.8 out of 5 stars 21 reviews

Combination treatment

Yes a repeat facelift can be performed, which will provide some further improvement to the areas you are concerned with.  But being careful is important as well.  Facelifting does not always remedy all concerns.  I would start with filler and laser lipolysis (subcutaneously), and/or fractional CO2 laser prior to considering another facelift.  If after these measure you are still concerned about these areas, another facelift (preferably at least 6 or more months after previous facelift) can be performed.  I would do an extended deep-plane facelift to deliver the best tightening of these cheek and mouth area issues.  But a complete review of the before and after pictures is warranted prior to considering another facelift.

David Q. Santos, MD
Bellevue Facial Plastic Surgeon
4.3 out of 5 stars 21 reviews

Midface result from facelift

Thank you for the question and the photos. It is difficult to assess the situation without a full view photo. However, the area that seems to be highlighted by the photo is the marionette fold. Even with an excellent facelift, this area generally improves only somewhat. Additional techniques, such as fat grafting or laser resurfacing, are needed to improve the texture and contour of this skin. If you have further concerns about the midface (cheek and lower eyelid areas), then it would be worthwhile to discuss these with your surgeon. In my practice, I use a deep-plane facelift technique. This has a much greater effect on the midface tissues, allowing for release and repositioning of the cheek mound. Best of luck and take care!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 95 reviews

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.