Upside Down Smile Not Improved After Facelift and Fat Transfer?

Unfortunately the naslolabial folds and corner of the mouth are not improved significantly by traditional face lift surgery. A direct corner lip lift can improve this area directly. It is an in office procedure that has a quick recovery time. You need to be accepting of a small scar along the lip line but for most patients this is not perceptible.

Poor results after facelift surgery require you to send photos to  see what YOUR problem is specifically and then a proper answer can be made.

The muscles at the corners of the mouth sometimes attach very strongly to the skin and the corners as well. Pulling the face back with a facelift doesn't always fix this. Other treatments are using Botox to relax the muscle called the depressor anguli oris, filling the crease or even a procedure called an angle of mouth lift. The surgical option is the most reliable but may leave scars along the corner of the mouth.

This issue can best be improved with a combination of lifting (i.e. face lift) and filling (injectables or fat grafting). You had these treatments done - so I would anticipate a significant improvement.

From study of faces I learned about the vast variation in our anatomy and aging patterns. Therefore, this global statement may only fit partially your esthetic situation. In some patients, deep marionette lines can be very difficult to erase. Other treatments, that are not "routine", can be used such as corner-of-the-mouth lift (a small surgical procedure) or weakening the depressor anguli oris (DAO muscle). This weakening can be done surgically as part of the facelift or with the help of Dysport or Botox.

Talk to your facelift surgeon what he would recommend to improve the remaining areas of concern.

Facelifts can help this to a degree. Much of your aging is volume loss related. Around the mouth you can volumize to improve this appearance and this is not achievable with a face lift alone. I would consider fillers or fat injections or other newer volumizing procedures.

Contrary to patient perceptions, a significant downturning of the corners of the mouth will not be improved by any facelift technique. Now will any injection material drive up the corners of the mouth if they are more than slightly less than horizontal. In the really downturned commissures, a direct approach through a corner of the mouth lift is needed. This may be combined with vermilion advancements if one's lips are also extremely thin.

It would be very helpful to see pictures so that I could provide more specific advice.  That said, here are some observations that pertain to this challenging area.

 

There are a number of facelift techniques that do a wonderful job of improving the tone of the cheek, jaw border, and neck, yet do very little to help with the issues you describe.  Volume in the form of fat or injectible fillers helps some, but doesn't really go the distance.

 

One important point in your question is that you note that before and after the surgery, you couldn't smile.  This suggests that you may have an elongated upper lip.  There are techniques of excision, either at the corner of the mouth or at the base of the nose, that may be helpful for this type of lip.  These are tricky techniques, and I would recommend that your seek a plastic surgeon who is highly experienced in them  For a discussion of these techniques see the Aesthetic Surgery Journal March 2009 29:2 83-86.

 

One of the best strategies that I will sometimes employ for a downturned corner of the mouth was developed by Dr. J William Little of Washington, D.C.  This involves a vertical tightening of the cheek structures along a line that runs from the base of the ear to the base of the nostril.  This can convert a sad looking mouth to one that looks peaceful, almost sublime.  Again a tricky technique.  Look for a board-certified plastic surgeon who knows this technique well.

 

Sorry for the somewhat technical discussion, but I hope this is helpful.

During aging, the corners of the mouth often descend creating a downturn to the corners of the mouth that makes you look like you're frowning.  This occurs in conjunction with deepening of the marionette lines and thickening of the jowl.  In my view, facelifting does very little to help with this problem.  Jowls and overhanging skin can be mostly flattened out but an artful facelift expressly AVOIDS distorting or changing the shape of the mouth.  Injectable fillers and fat injection can be used to build support for the corners of the mouth and fill in the marionette line area at the same time.  Frustratingly, this rarely eliminates the unwanted features but does create a noticeable improvement. 

This is a problem related to loss of fat in the prejowel sulcus area from the inferior mandible to the corner of the mouth. A refilling of this area skillfully by an expert in fat injection will improve it immensely. A corner mouth lift operation does address this but a small scar at the corner of the mouth is left

  OK, I must confess that I'm confused.  From your posted question it appears that you still have jowls and Marionette Lines, with severely thin lips, after your Face Lift Surgery.  Without photos, of your face, I'm not sure how we could recommend anything at this point.  At the very least, aesthetically, you might want to have some form of Lip Augmentation and fillers to the Marionette Lines.