Facelift redo - do I need a full lift or would a lower facelift be a good choice? (Photos)

Question

Hi, I had a Smas facelift 4.5 years ago and a fat transfer, I am aware that neither is permanent but I literally feel like I never had it. I do not blame my surgeon for I think He is great but I'm feeling like I am still chasing the problems I started with. I am doing microneedling, and botox and filler and have been for years now. I lost all the fat and my skin is droopy, ugh! Is a full repeat facelift the answer or a lower facelift do the trick.

Andrew Miller, MD · Answer

Based on your photo, you are a great candidate for revision deep plane facelift with possilby some facial CO2 laser at the same time to address wrinkles. The deep plane is needed to avoid the lateral sweep you are developing and will get worse with another SMAS lift. Be sure to see a facial specialist for consultation.

Kyle Kimura, MD · Answer

Thank you for your photos and question. 
I think you experience is fairly common when it comes to SMAS facelifts. Any time your lift is based on a significant amount of tension, that will lead to drooping and relapse of the tissues over time and is why many surgeons prefer a true deep plane lift which focuses on a release of the many of those tension points and redistributing the tissues under less tension. While I think it is ultimately up to the patient about a revision neck vs full face and neck lift, my recommendations would be to address both the face and neck. I have seen in some situations where the neck looks beautiful and rejuvenated and the face has not been addressed and it can sometimes look a bit odd or mismatched. As such, for most patients over 50 I will recommend both face and neck be addressed. 
I think your best bet is to schedule a consult with a plastic surgeon that specializes in face lifts (preferably deep plane) and discuss your best options moving forward.
Hope this helps and best of luck! Kyle Kimura, MD

Pedro Literas, MD · Answer

Thank you for your thoughtful question and for sharing your photos.It’s not uncommon for patients to notice recurrent facial laxity several years after a SMAS facelift. While facelift surgery provides long-lasting rejuvenation, it does not stop the natural aging process. Over time, changes in skin elasticity, ligamentous support, and especially loss of facial volume can contribute to the return of jowls and neck laxity.Based on your description, both a revision facelift and a lower facelift may be appropriate options, depending on the extent and location of the aging changes. A lower facelift primarily addresses the jawline and neck, and it can be effective when concerns are limited to these areas. However, if there is also midface descent or a desire for a more comprehensive and longer-lasting result, a revision or deep plane facelift may provide superior rejuvenation by repositioning the deeper facial structures.The perceived loss of the benefits from your previous fat transfer is also common, as some of the grafted fat may resorb over time. Additional fat grafting or other volumizing techniques can be combined with facelift surgery to restore facial harmony.Ultimately, the best approach depends on a detailed in-person evaluation, including assessment of skin quality, residual SMAS support, and volume loss. Consulting with an experienced, board-certified facial plastic surgeon will help determine the most appropriate and personalized treatment plan.Dr. Pedro LiterasFacial Plastic Surgeon

Facelift redo - do I need a full lift or would a lower facelift be a good choice? (Photos)

Answers (3)

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