Dear Xelaju, Thank you very much for your clinical post and well done serial photography.From the description of your concerns and photographs it does appear that you have some loss of volume in the mid face with some descent of the cheek and early pre-jowling, which affects the depth of your nasal labia fold. There’s also some asymmetry of the left cheek being somewhat flatter than the right, which may indicate that you sleep on the left side of your face more than the right side as your nasal labia fold is deeper and more extensive on the left side. Analysis of the views you provided with your nose shows relatively nice rhinoplasty skeletal dorsum, but a slightly long and over-projected tip. There’s some degree of supratip fullness and Polly Beak appearance with a hanging columella. This is a long elegant nose, but still there is some nasofacial imbalance and proportion with a dominant nasal projection. You certainly can perform both an endoscopic mid facelift or mid facelift procedure together with your revision rhinoplasty and, in fact, one anesthetic and one recovery would be preferential to two. Mid face repositioning in my hands would be performed through the temporal hairline and in the mouth approach.I create an elevation of the mid face fat above the bone and then re-suspend this until the soft tissue of the cheek heals to the underlying bony anatomy creating a very long-term improvement in your cheek contour, improvement in the lower lid deflation that has occurred with age and some improvement resolution in the smile lines. This will certainly provide a much longer term improvement than soft tissue fillers or fat grafting to the face. At the same time revision external rhinoplasty to improve the nasal tip projection, hanging columella, slight alar asymmetry (the left side being more collapsed than the right) can be performed. These are complex procedures and you would want to seek the consultation advice of rhinoplasty surgeons and plastic surgeons with extensive experience in both. I am fortunate in being trained in both plastic surgery and ear, nose, throat, head and neck oncology and facial trauma. I have been performing endoscopic mid facelifts and external rhinoplasties for over 20 years and feel that you may be a good candidate for this combined approach. I hope this information helps and best of luck. For more information, please review the link below. R. Stephen Mulholland, M.D. Certified Plastic Surgeon Yorkville, Toronto