A 56-year-old female presented with concerns about recurrent lower facial aging, jowling, and volume descent following a prior facelift procedure performed 7 years earlier. The patient expressed dissatisfaction with the durability and naturalness of her previous results, noting an early return of heaviness in the lower face and marionette areas.
She was healthy, non-smoking, and maintained a stable weight. Her primary goal was a refreshed, natural look—particularly in the cheeks and jawline—without signs of over-tightening or artificial contours.
Clinical Findings
Physical examination revealed:
- Moderate jowling with descent of the lower cheek fat
- Residual marionette line hollowing
- Midface volume deflation
- Skin laxity and lateral tension from the previous facelift
- No platysmal banding or significant cervical skin redundancy
Given the absence of neck aging signs or patient complaints regarding neck contour, a revision deep plane facelift alone was deemed appropriate.
Surgical Approach
A revision deep plane facelift was planned to reposition descended midface tissues, address perioral sagging, and create natural vector lifting. The procedure included:
- Release of residual scarring and previous SMAS manipulation
- Vertical vector lifting via deep plane dissection to mobilize and elevate the cheek fat pads
- Structural rejuvenation with tension redistribution over a robust SMAS flap
- Conservative skin redraping with meticulous incision closure to camouflage scars
Neck lift or subplatysmal work was not indicated or performed.
Intraoperative Summary
- Anesthesia: General
- Duration: ~3.5 hours
- Procedure Highlights:
- Deep plane entry from the zygomatic arch to jawline
- Elevation and repositioning of midface soft tissues
- SMAS elevation and re-suspension without manipulation of neck structures
- Skin closure with minimal tension to support long-term natural results
Visual Outcome
Notable Changes:
- Harmonious facial contouring
- Lifted cheeks and lower face definition
- Preservation of facial expression and dynamic movement
Op. Dr. Erman Ak who is one of the best cosmetic and plastic surgeon in Turkey, completed his specialization at Istanbul University Çapa Medical Faculty. He received advanced microsurgery training in Taiwan and, as an ISAPS fellow in Italy, training in facial and breast aesthetics. Dr. Ak holds the European Union Aesthetic Plastic Surgery qualification certificate from EBOPRAS and contributed to the establishment of the Plastic Surgery Department at Başakşehir Çam and Sakura Hospital. He currently accepts patients from Turkey and various other countries at his clinic in Nişantaşı.
