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A woman is 14 months after a facelift. Before, her face looked smooth and perfect. However, things changed and he wants to know if her face has a lateral sweep. Dr. Amiya Prasad, a cosmetic oculofacial plastic surgeon, explains that when evaluating a patient with any unusual appearance after a facelift, it takes more than a photo to guide someone. As a surgeon, he would advise that she meet the original surgeon who did her facelift. If everything looked very good until recently, then chances are that her surgeon will have an explanation for what happened. Every surgeon who does face lifting surgery has their own signature style and has an understanding of what their patient looks like during their procedure. There are many reasons why someone has a relative lateral sweep. It has to do with the relaxing of every face and neck lift procedure. It is the intention as surgeons to maximize the tone of the muscle under the skin called the SMAS, or the superficial musculoaponeurotic system, as well as to redrape and trim the excess skin so that it goes on very smoothly, looks nice, natural, and does not have vectors of tension. When someone has lateral sweep tension, it can sometimes be from descent of one area of the face where it was higher and came down almost like a pleat action. It could be the resolution of swelling that was present and made the area look better before, but then the swelling went down. Changes in tissue dynamics cause this pleating. Lastly, it could also be the skin quality. There are many different ways to look at this type of issue and in a physical exam, the surgeon would actually vertically lift different areas and feel for areas of tension and opportunity. This may be something that is amenable to fillers. It could also be amenable to minimal enhancement. Although this woman submitted a very good photo, Dr. Prasad thinks that a physical exam has to be performed. If she is comfortable with her original surgeon, then that's probably where she'll find her solution. If for any reason she isn't comfortable, then getting additional opinions is warranted. Meeting with a doctor and getting additional opinions will give her a better idea on what's going on at the 14th month point of her process.