Upside Down Smile Not Improved After Facelift and Fat Transfer?

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.