78, 25 years post facelift. What would you recommend for the cheek, mouth and neck areas? (Photo)

Question

Hello, I am 78 years old and have developed a lot of wrinkles since having a facelift 25 years ago. I’m happy with the eye area, but I would like the cheek and mouth areas, as well as my neck, to be smoother. What would you recommend?

Gary M. Horndeski, MD · Answer

I recommend an eccentric lip lift, not a bullhorn lip lift. This does 4 things: shortens the distance between your nose and upper lip, increases the mucosa of the upper lip, increases the incisor show and pulls up the corners. This takes 1 hour to perform under local anesthesia and costs $4,000. You would not need medial clearance for this procedure. If you want something more invasive then you would benefit from a neck and lower face lift. However, you would have to be medically cleared for surgery before having that done.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Serdar Bora Bayraktaroglu, MD · Answer

I recommend a comprehensive, tailored revision approach for your concerns at 78. A revision deep-plane facelift and neck lift is ideal to safely navigate existing scar tissue, reposition fallen cheek tissues, tighten the underlying platysma muscle, and restore a smooth neck. Because a quarter-century of facial aging involves structural volume loss, combining your lift with autologous fat grafting will restore soft fullness around the cheeks and mouth. Finally, since surgical lifting cannot erase fine surface wrinkles, fractional CO2 laser resurfacing will smooth perioral skin texture. Consult a board-certified plastic surgeon specializing in revision facial procedures.

Kyle Kimura, MD · Answer

Thank you for your question and photo. 
The question will always come down to whether you would need a revision facelift or something less invasive like laser resurfacing. In particular, the finer wrinkles around the mouth will respond better to laser than another lift. The fullness of the neck and jawline will respond better to a lift. Your best option would be scheduling a consult with a plastic surgeon well versed in facial rejuvenation to discuss these options and determine the best choice for you.
Hope this helps and best of luck,Kyle Kimura, MD

Mert Demirel, MD · Answer

At 78, the best plan depends first on your overall health, skin quality, medications, and what bothers you most. Age alone does not automatically prevent treatment, but safety and recovery become more important.
If the main issue is loose skin and recurrent sagging after a facelift 25 years ago, a secondary facelift or lower face and neck lift may be an option. This can improve jawline, cheek descent, mouth-area laxity, and neck looseness, but it is more complex than a first facelift because of prior scar tissue.
If the main issue is fine wrinkles and skin texture, surgery alone will not fully smooth them. For wrinkles around the cheeks and mouth, treatments such as laser resurfacing, chemical peel, microneedling, or conservative filler/fat grafting may be more useful, depending on skin thickness and healing ability.
The neck may need a different approach than the face. If there is loose neck skin or platysma banding, a revision neck lift can help. If the skin is very thin or crepey, resurfacing or skin-quality treatments may be needed in addition to any lifting.
My advice would be to consult a board-certified facial plastic or plastic surgeon experienced in secondary facelifts in older patients. Ask for a plan that separates lifting from skin resurfacing: surgery for laxity, and skin treatments for wrinkles. A conservative, staged approach may be safer and more natural than trying to correct everything at once.

Don W. Griffin, MD · Answer

Thank you for submitting your photo and questions. It appears from your photos that you have recurrent laxity of the lower face and neck with elongation of the upper lip and deep lip lines. The best way to address these issues would be re-lifting of the lower face and neck combined with a lip lift procedure to shorten the upper lip. You would also benefit from laser resurfacing off the perioral area and lip filler, but these may be better to do at a separate session from the surgical procedures. I would advise that you contact a board certified plastic surgeon or facial plastic surgeon for consultation.

Muhsin Yilmaz, MD, FEBOPRAS · Answer

At 78, and with your last facelift being 25 years ago, it is completely understandable that you are seeing more laxity and wrinkles again. A facelift does not stop the natural ageing process, and after 25 years, the tissues have had plenty of time to change.
Since you are happy with your eye area, I would focus on the cheeks, lower face and neck. A secondary facelift with a proper neck lift could address the loose skin and jowling while also improving the folds around the mouth and the overall transition from the cheeks to the neck.
I would be careful about trying to correct this only with fillers or non-surgical treatments. At this stage, if there is significant skin laxity, surgery would usually give a much more noticeable and longer-lasting improvement.
Of course, at 78, your overall health and medical history are very important when considering surgery, so you would need a thorough consultation and medical assessment first. But based on what you describe, I would definitely consider a well-planned facelift and neck lift rather than simply treating individual wrinkles.

Eric Chang, MD · Answer

Twenty-five years is a long run for a facelift, and it's common for the cheeks, mouth area and neck to show renewed laxity and volume loss even when the original results held up well. For the cheeks and neck, a revision facelift combined with a neck lift is typically the most effective way to re-establish support and definition. The mouth area is often a separate issue involving lengthening of the space between the nose and upper lip, and a lip lift can shorten that distance and restore a more youthful lip show without a large procedure. Fine lines and surface texture changes respond better to resurfacing treatments like fractional laser than to lifting alone, since a facelift repositions tissue but doesn't fully address skin quality.

A full evaluation is needed to sequence this properly and confirm you're a good surgical candidate. See a board-certified plastic surgeon for an in-person consultation.

A full evaluation is needed to sequence this properly and confirm you're a good surgical candidate. See a board-certified plastic surgeon for an in-person consultation.

Julian De Silva, MD · Answer

Hi annkstr, thank you for your question, and it is lovely to hear you are still happy with your eye area 25 years on.

From your description and photo, the changes you describe are usually a combination of three different processes rather than one: some renewed descent of the deeper tissues, some loss of facial volume in the cheek and around the mouth, and changes in the skin quality itself, which is where fine wrinkling and smoothness really live. Each of these is treated differently. Lifting procedures address descent, particularly in the neck and jawline, but they do not smooth the skin around the mouth, where skin-quality treatments or volume restoration often matter more.

At 78 many patients remain good candidates, but a careful in-person examination and a full review of your general health and medications is the essential first step before anyone recommends a specific procedure. I would encourage you to see a facial specialist who can examine your skin quality and tissue laxity together and talk you through the options honestly, including the gentler non-surgical ones.

78, 25 years post facelift. What would you recommend for the cheek, mouth and neck areas? (Photo)

Answers (8)

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