Loose skin in lower face 12 mos after deep plane facelift. What are my options to correct this? (Photo)

Question

I had a deep plane facelift and necklift 12 mos ago. There was some tightening in the neck and a little in the jowels, but I still have a lot of laxity around my mouth/jowels. I went to a double-board certified Beverly Hills surgeon, so I expected to have a taut, sag-free face. Is the midface addressed in a deep plane facelift and should this area be tighter? What are options to correct this? A revision deep plane facelift? A midface lift? Other? What is an acceptable resolution with the surgeon

Gianfranco Frojo, MD · Answer

I would recommend a secondary/revisionary facelift/necklift with facial fat grafting. There does not seem to have been adequate tightening of the deeper structures of the face/neck nor adequate skin redraping. There is also displacement of the ear tragal component. I would find a plastic surgeon certified by the American Board of Plastic Surgery. I always tell prospective patients to look at the plastic surgeon's training (ideally a 6 year integrated plastic surgery residency and a 1 year aesthetic fellowship accredited by The Aesthetic Society). Also be careful to check what board certification has been obtained...only the American Board of Plastic Surgery is accredited by the American Board of Medical Specialties. Other entities such as the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Cosmetic Surgery are NOT accredited by the American Board of Medical Specialties. In addition, examine before/after photos on social media platforms. I would also look at Google or RealSelf reviews. This will help you get a comprehensive understanding of your provider.

Raffy Karamanoukian, MD, FACS · Answer

Ultherapy is a non-invasive procedure that lifts the neck, chin and brow, and improves lines and wrinkles on the upper chest. As we age, collagen breaks down, resulting in loss of skin strength and elasticity. For tissue tightening, Ultherapy is ideal for the lower face and neck and we often combine it with CO2 laser or Morpheus8 to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anil R. Shah, MD · Answer

It's quite common to experience loose skin in the lower part of the face following a facelift. This can be influenced by various factors, such as the adequacy of mobilizing deep tissues, your individual anatomy, and whether the skin was properly addressed during the procedure. Loose skin concerns can be managed with resurfacing lasers or medical-grade skincare. Given that your surgery took place 12 months ago, it's advisable to consult with your surgeon about addressing the deeper tissues and determining if your skin has sufficient laxity for a revision.

Lexie Wang, MD · Answer

Hi! The midface is supposed to be addressed in a face lift, although you should make sure that it was since sometimes it is not addressed in certain kinds of "mini" face lifts. From looking at your scars, my suspicion is that the intent was to address that area but I'm not 100% sure.

The main thing that I am possibly noticing is the skin laxity. This is, unfortunatley, something that can happen after a deep plane style face lift since the purpose of that surgery is to not tighten skin but rather to lift underlying structures below the skin. That means that, deceptively, sometimes the skin remains "loose" even after surgery, especially the further away it is from where it has been pulled (i.e. closer to the middle of the face). Usually what I tell my patients for this is that they need to work on maximizing their skin tone/quality to get that tight skin back, such as doing treatmenst like laser/RFMN.

Ronald J. Edelson, MD · Answer

You could have a minor revision to tighten up the jawline. Otherwise your facelift looks good. I would discuss this with your surgeon

William Portuese, MD · Answer

You have a very natural look after your facelift however, you do have additional laxity in the neck, which would require a revision face neck lift procedure. Very important not to look too stretched, pulled, or wind tunneled. A facelift does not address the mid-face.

Darryl J. Blinski, MD · Answer

Based on your nicely posted, photos revision of the plane facelift is becoming more and more common because of less tightening affect or more laxity left. I recommend revision using mini face and neck techniques of skin lifting with some SMAS plication. Fee $10,000. Best to virtual consult with.