Follow-Up: Crows feet far worse after facelift. What can be done now? (photo)

Question

Hello, I've asked for help with this problem before. My crows feet are far worse after a facelift and not natural looking. Particularly the left side which has distinct folds when I smile. As suggested on realself I had botox, 3 months ago and again 2 weeks ago. I also had deep laser performed 8 weeks ago (full field ablative Sciton erbium). However dispite this my crows feet are still significant, but what bothers me the most is the unnatural looking folds. Please help.

Ben Lee, MD · Answer

This happens occasionally after a facelift. As you can imagine, when you lift the mid and lower facial tissues superiorly and posteriorly, it can make the areas around the eyes worse. Botulinum toxin helps, but not completely. It is sometimes necessary to lift some of the temporal skin at or behind the hairline. This can make a tremendous difference and can be done under local anesthesia. I would consult with your original surgeon to go over options.

James M. Ridgway, MD, FACS · Answer

Dear Aussie,Thank you for your question.  As mentioned, you have been abnormal and excessive rotation of the facial flap bilaterally, left greater than right.  Correction, unfortunately, would require another surgical procedure. There are some challenges with a revision procedure as you appear to have had your incision placed in front of the ear tragus (the pointy part of the ear in front of the ear canal) on both sides.  This makes a corrective procedure more possible, but it also makes any surgical result more visible.  I hope this helps you as you find the best answer for you.My best,James M. Ridgway, M.D., FACS

Kevin Sadati, DO · Answer

You have a well performed facelift. However, during animation you have exaggerated crow's feet and wrinkles on your cheeks. I would recommend two procedures to improve these problematic areas. First get treatment with Vivace, a radio-frequency and micro-needling device, to tighten the deep tissue. Then have volume added to the area using either temporary fillers or  Fat Grafting with PRP for a permanent results.  You certainly required to have volume replacement in the area.

Boris M. Ackerman, MD · Answer

You have somewhat unusual problem, as you look quite good when not smiling.  Since Botox and laser treatment did not provide any improvement, the next step would be Structural Fat Graft in the affected area.  This treatment could possibly provide some tissue that would allow for better skin distribution when smiling.

Karan Chopra, MD · Answer

It appears that you've experienced an abnormal and excessive rotation of the facial flap, particularly on the left side. I'm sorry to hear about your experience.

To address this issue, a corrective surgical procedure may be necessary. However, I'd like to highlight that there are unique challenges involved due to the initial incision placement in front of the ear tragus on both sides. While a revision procedure could potentially improve the situation, it's important to consider the visibility of any surgical outcomes due to this incision placement.

If you have any more questions, feel free to reach out to me at chopraplasticsurgery.com.

Gary L. Ross, MBChB, FRCS · Answer

It sounds like your PS has offered you every non surgical option to try and improve this. With time there may be some improvement but if things have not settled at the 12-18 month point you may need revisionary surgery to elevate the skin flaps and reposition them.

William Portuese, MD · Answer

This appears to be related to several issues which include a very strong smile muscles, and thin skin along  With misdirected re- draping of the skin during the facelift procedure.  A revisional facelift procedure should be able to correct this along with some Botox.

Kyle S. Choe, MD, FACS · Answer

Botox should help relax the muscle around your eyes and crows feet area. The other option is to have a temple lift to undermine and lift the skin and muscle where your skin in bunching. This is a simple procedure that takes about an hour.

Andre Panossian, MD · Answer

The manner in which the original facelift is performed can have an impact on excessive folding or an unnatural appearance.  Tightening of the underlying musculature (aka, SMAS layer) by way of a deep technique can elevate the muscle-skin unit together.  Also, it may be that tailoring of the overlying skin may have favored too much bunching at the level of the top of the ear.  The skin must be evenly distributed in order to properly redrape.  Your problem is a dynamic one, in the sense that it is unmasked with smiling but looks good when at rest. As the surgeon, it is important to note this discrepancy and to make adjustments during revision surgery. Also, simultaneous fat grafting may improve cheek volume. These are correctable issues.

Glenn Vallecillos, MD, FACS · Answer

Hi and thanks for the question. In review of your photos and comments, Botox may help in the accentuation of crows feet, but the unnatural look you're describing is fundamentally due to the type of facelift you had.  A lot of facelift incisions end at the top of the ear - if you have a lot of redundant or extra skin, you can see the stigmata of skin bunching as you are describing. Its akin to redraping fabric. I prefer high SMAS facelift with an extended incision well into the hairline ( well hidden).  This gives two advantages: Superior mid facial elevation and cheek augmentation, and extended releasing of skin in the temporal region with associated excision of redundant skin. The good news is that your issue is absolutely correctable. Best of luck,Doctor Vallecillos, MD, FACS, Board Certified Plastic Surgeon.

Follow-Up: Crows feet far worse after facelift. What can be done now? (photo)

Answers (17)

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