3 months after facelift I have large bag of loose skin at the edge of my mouth. Can you cut it out along the naso labial folds?

Question

I an 65 and had a face lift 3 months ago. I now have bag at edge of my mouth and on my chin that I didn’t have before. I also have swelling on chin that has never left.The plastic surgeon suggest cutting that little piece out along the naso labial fold. He may have to go a little farther down than that. I am concerned about scarring. I am also starting to get a loose pocket on the other side.I hate to have to do fillers forever. I got the facelift so I wouldn’t have to do that. What can I do?

Michael I. Echavez, MD · Answer

It would be helpful to see pictures of your face and neck before and after your facelift.  Usually, sagging skin beside and below the mouth would be improved after a facelift, so I'm uncertain why this issue developed after your facelift 3 months ago.  It is possible to directly excise loose skin along the lower nasolabial fold and normally the incision can be placed in an existing crease to camouflage it.

Thomas A. Mustoe, MD, FACS · Answer

Yes, it can be cut out but the risk of a visible scar is indeed very high.  I don’t know what technique was used with your facelift, but it appears to have been very conservative.  In general, the best solution for your problem is a combination of a facelift that truly lifts the midface and mouth( I think deep plane is the best approach) with added volume ( I use fat because it lasts much longer and is amenable to larger volumes and sometimes resurfacing.  Visible scars cannot be corrected.  You do have a lot of skin laxity and it will never be fully corrected but a mor improvement should be possible with a secondary facelift.  I think that is the best approach.  However even after a well done facelift some patients still benefit from periodic fillers for an optimal correction/

Scott Trimas, MD · Answer

That is often a challenging area to correct and not have your mouth area look too tight or have a done look. Sometimes some simple liposuction to the area or fillers nearby can help. I prefer not to remove the skin in that area as the scarring can be visible and it's always best to avoid a scar in the central facial areas if possible. You might want to discuss with your surgeon other options.

Brian K. Machida, MD, FACS · Answer

Its important to see your pre op photos to see any improvement. These lines at the corner of your mouth would be difficult to make “gone” because it is at the furthest most margin of effect of your lift. A full facial view would help to see how this balances with the rest of your face. You also have some finer lines and wonder if a laser was done. It’s always best to get a personal consultation for questions.

Ravi Dahiya, MD · Answer

The area that your picture highlights can be very challenging. Simply pulling with a surgical lift will not address the laxity of looseness of the skin there alone. Often it requires other measures such as using a filler (and there are a few great long lasting fillers available) to restore volume and laser resurfacing to tighten the skin. This is what I describe as being a three dimensional approach the rejuvenation. This works because aging affects all of the layers of tissue in the face so improving each layer or aging factor has a synergy that provided a more youthful and comprehensive result. So you have several options that can improve your result.

Dean P. Kane, MD, FACS · Answer

Dear sfg23:Thanks for sharing your photos. They are helpful. At 3 months following a surgical procedure, you should have optimal tightness of the tissues. It appears the marionette fold you are concerned about is relaxation of the skin itself or lack of adequate facial skin lift and redraping.You may consider:Return to your primary facelift surgeon and consider a secondary facelift once the tissues have matured; about 12 months. Performing a fold excision will not only leave a scar leaving the jowl and additional neck laxity but will further relax. Second opinion from a Board Certified Plastic Surgeon to review your operative note for the type of facial procedure you had and make recommendations.Non-surgical options include:Tightening procedures such as Sculptra injection, ThermiTight, Silhouette InstaLift / EuroThreads.Obagi, ZO Skin Health retinoids and TCA peelsI recommend against fillers as they will "fill" or enlarge the lower face, reducing the impact and balance of "lifting" the sagging tissues of the face for which you sought a facelift. I hope this has been helpful. All the best!

Robert S. Schmidt, MD · Answer

Thanks for your question. I can see what you're talking about. It can be tough to get correction in this region from a standard facelift technique. I bet that your doctor's suggestion would work, but you would have a scar there that could be visible. Fillers are an option, but you're correct to say that they would have to be repeated. An additional option would be to try radio frequency treatments like Pelleve that help to tighten the skin non-invasively. I wouldn't guarantee that it would 100% fix the issue, but it would be a way to improve it without risking a scar. Good luck!

3 months after facelift I have large bag of loose skin at the edge of my mouth. Can you cut it out along the naso labial folds?

Answers (7)

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