Another facelift or fat transfers? (Photo)

Thank you for the photos you have posted. While not as informative as seeing patients in person and assessing their tissue quality, the photos are certainly helpful. You are indeed experiencing continued gravitational descent of the face, which happens with ageing. (While I do understand that it's frustrating to look older, remember that growing older is a gift that not everyone receives.)

I do not know what kind of facelift techniques your original surgeon implemented; however, I'm guessing that the lift was somewhat superficial, since your "after" photo still shows marionette lines. I would wholeheartedly discourage you from getting fat transplantation without any other surgery, as this will not only distort your natural anatomical landmarks, it will also make your face heavier and will do nothing to correct the signs of ageing. I would suggest finding a surgeon who is expert in hybrid facelifting -- that is, using a combination of the Deep Plane, SMAS, and Subcuticular approach. I have found that using the hybrid approach in cases such as yours produces excellent, long-lasting results. It is possible that you would not need fat grafting depending on how your tissues behave in surgery. I would also suggest a lower-eyelid blepharoplasty to remove the "puffs" of your lower lids.

What treatment you choose really depends on what your concerns are now. If you want to address laxity to the neck and face, this is best treated with a facelift. As we age we lose volume in the face and we develop hollowing. Fat transfer can replace the last volume but it does not significantly lift the facial tissues.

This is a good question and there is not one single right answer. You could actually start with some facial filler like Sculptra, which would help. Or, be a little more aggressive and repeat the fat transfer, which would be my suggestion. Another facelift may be in your future but I think that is a big surgery for a small problem based on your photos. Hope that helps!