Can a SOOF lift be reversed?

Question

I had a SOOF lift 1.5 years ago, and every time I smile I feel something pressing on my right eye from underneath. Sometimes if I rub underneath it alleviates it until I smile again, but it is very irritating. My original doctor is very dismissive and says it couldn't be from the SOOF, and I'm not sure what I should do. Is there anything specific it could be? Can a SOOF be reversed? I have really been disappointed with the outcome.

David Gilpin, MD · Answer

Thank you for your question, and I am sorry that you are having these concerns after your lift. I typically would direct you back to your surgeon; however, it sounds as if he/she is not being responsive to your concerns.  I would then seek out a second consultation with a board certified facial plastic surgeon, oculoplastic surgeon, or plastic surgeon who has experience with lower eyelid rejuvenation and with the SOOF lift.  The symptoms you are describing possibly could be from a retaining suture (stitch) or from the surgery itself with excessive volume lifted into the midface.  I hope that this helps. -David Gilpin

Lucas Bryant, MD · Answer

Jenna, thanks for your question. I'm sorry you are disappointed. There are often treatments that can be done to address postoperative issues. If you are not happy with your surgeons recommendations, you could consider a second opinion from another facial plastic surgeon or oculoplastic surgeon.

Kenneth D. Steinsapir, MD · Answer

SOOF lifts are far from benign surgeries. The surgeons who perform them often do not understand the potential complications from them. Perhaps one of the most important issues that is likely irreversible is that the way the lower eyelid muscle heap up with the smile are permanently changed. I would be very careful rushing into a solution here that can have dire consequences to your appearance. I fix many lower eyelid/midface issues after failed SOOF lifting. Not a lot of surgeons are doing this type of work so be very careful in deciding on how to "fix" this.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  If some type of suspension method along the lower eyelid area was used during the SOOF lift, this might account for what you are describing.  You might want to ask your surgeon if that is indeed the case and if the suture can be cut or removed. The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.  
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 In my experience, this is the "key" factor in making the face soft, feminine and naturally beautiful.  An essential part of any facelift on a woman.  Conversely, men look chiseled and handsome when angularity is created in the cheeks, chin and mandibular angles.  The ability to provide precise, facial shaping separately or in combination with a facelift is in my humble opinion the definition of a "facial shaping expert".
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
Hope this helps.

Marc J. Salzman, MD, FACS (retired) · Answer

I'm sorry to hear about this undesired consequence after your facelift. Since this problem is dynamic, this is something the physician will need to see in action before plan for repair can be done. If you're unhappy with your present surgeon, it does no harm to seek consultation from a few others. Hope that's helpful.

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