This is 63-year-old woman with a history of upper blepharoplasty 5 years prior who had been using fillers to treat her volume loss and jowling for years now presenting to discuss surgical intervention to address these areas.
On physical examination, she lacks lower eyelid puffiness (steatoblepharon), but has a moderate orbital groove and a mild malar groove. She does have strong underlying cheek structure. She also has a mild pre-jowl sulcus and perioral volume loss. Her lower face shows significant jowling with midline cervical adipose and laxity, but good underlying anatomy.
To address her concerns, she underwent a lower facelift with cervical liposuction, jowl microliposuction and plastymaplasty and a lower 2/3 autologous fat transfer. When comparing her pre and postoperative imaging, the patient looks refreshed and not overdone. Her frontal and oblique imaging shows significant improvement in her marionette lines and jowls. The lateral view shows the marked improvement in the neck. On the oblique photos, the midface volume has been noticeably restored and she has a soft, youthful appearance.
She is now 4 months out from her procedure and loves her neckline and how youthful her face looks after the fat transfer.