Is a deep plane facelift my only option or are there other suitable techniques/approaches? (Photos)

Question

37, female. I have mild facial asymmetry from a jaw growth discrepancy (right side longer). In my early 30s I had dermal filler to camouflage it, which worked fwor a few years, but multiple rounds with different practitioners without dissolving left me overfilled and distorted. The extra weight and volume on the right was pulling that side down and making the asymmetry more noticeable. About 6 weeks ago I had most of it dissolved, unguided and without ultrasound. I think some remains, and I'm waiting for an ultrasound-guided appointment to dissolve the rest. I'm now left with deep tear trough/malar indentations (present since childhood, now much worse), mid cheek volume loss, and lower cheek hollowing and sagging. The sagging is worse on the right (the longer jaw side), especially around the mouth: a deeper right marionette fold and the right corner of my mouth drooping more. When I lift my right upper cheek slightly, the mouth droop and marionette fold disappear, so I think mid cheek descent is the main cause. I don't know whether the overfilling permanently stretched the tissue and made this side droop more after dissolving. A surgeon has recommended a deep plane facelift, with a small amount of SMAS fat grafted into the tear trough/malar indentation. My question is: Would I be suitable for any less invasive surgical options, such as other facelift techniques or fat grafting to more areas?

Ronald J. Edelson, MD · Answer

I think the question is whether you need a facelift at all. That’s generally too young for a facelift but it’s hard to tell from the photos. There are many surgeons who would do a facelift on you and there are different types of facelifts, although they share more similarities than differences. Go for a few consults to see what different surgeons say.  Also I would avoid fat transfer. It will be no better than all the fillers you’ve already had

Randal Haworth, MD, FACS · Answer

Deep-plane facelifting is one way to reposition descended midface and jowl soft tissue. It is not the only legitimate approach, and it is not automatically “better” for every face.

The decision hinges on where the aging is: skin laxity, SMAS descent, fat deflation, neck banding, and bone support. Some patients need volume (fat) more than lift; some need neck work more than cheek elevation; some need a well-executed SMAS or extended-SMAS technique rather than a marketing label.

Photos of the amount of lift you want at a young age also raise the question of whether surgery is appropriate yet versus fillers, skin quality treatments, or waiting. That is an exam decision with a facial specialist—not something a technique name settles online.

Mats Hagstrom, MD (license on probation) · Answer

I’m not sure if facelift is going to treat the areas of concern.
Look carefully and before and after pictures of other patients, who’ve had the same procedure and see what part of the face actually changed.
Best,
Mats Hagstrom MD

Is a deep plane facelift my only option or are there other suitable techniques/approaches? (Photos)

Answers (3)

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