Lower Facelift and Platysmaplasty 8 Weeks Ago and I Still Have Lump Under my Chin

Is this normal or do I need liposuction? Prior to surgery my PS didn't think it was necessary and I didn't either(I am slender w/ good skin elasticity). When I saw him last we discussed the neck bands still present and the lump. He said that he should have done liposuction. I am not so sure although the neck bands are still there. I just think this may be a seperate issue and I don't want to have any extra unnecessary surgery. I am reading that these lumps are not so uncommon. Thank you

Doctor Answers (8)

Lump under chin after lower facelift and platysmaplasty

+2

If you and your surgeon didn't feel a need before surgery to address this area, the swelling and fullness you see now under your chin should improve over time, though this will take several months to completely settle. I'm sure both you and your surgeon will agree that nothing was "added" to this area other than post-operative swelling and perhaps some fluid or blood. The latter can cause increased scar fibrosis and result in subcutaneous firmness and persistent bulging in this area, but can also be reduced with massage therapy, infrared treatments, and ultrasound (we offer these treatments as part of our post-operative care regimen in our office surgical center), and possibly steroid injections. If a collection of fluid or blood is identified early, this should be addressed via aspiration or re-operation, but this is not possible now--the fluid part is long gone and all that remains is swelling and/or scar tissue.

What is clear is that only time and resolution of the swelling component first, and then determining the scar fullness component, is needed before considering any kind of surgical revision. That way a proper and effective plan can be created. Rapid re-operation is something that patients (naturally, but incorrectly) want, and frankly, inexperienced and perhaps defensive surgeons fall prey to--premature re-operation is rarely good, and less likely to work out as everyone hopes. In fact, it often makes things worse (how do you think I know that?)

So, my best advice is to be patient for now, remain on good terms with your surgeon (not blaming or angry but understanding that he did his best and wants his best possible outcome for you as much as you do), and figure out a joint plan. I always do my utmost to make less-than-thrilled patients happy when they are thankful for what I have done, appreciative that I did not willingly wish their concern upon them, and are willing to do their part in covering OR and anesthesia costs as we discuss before their first operation.

Realize that the under-chin area is the most dependent area of the face and neck after surgery in these areas, and swelling, blood, and fluid, naturally tend to "go south" towards this region. Sleeping with your head elevated for the first three weeks after surgery and wearing an elastic shin strap for two weeks helps the tissues to adhere and heal evenly.

Neck bands are visible platysma muscle fibers that are visible before and sometime after facelift surgery. The exact procedure determines whether these are reduced, eliminated (rarely), or left alone, but complete elimination of these bands requires cutting the muscle--some surgeons do this fairly routinely; others decry this as causing a (different kind of) deformity. Partial division can provide some improvement, but would involve re-operation. Botox can offer non-operative relief of these bands, but need to be repeated every 4-6 months. Liposuction does nothing for muscle bands, but re-operation to address the residual fullness and the bands should be tailored to your requests and level of concern, but not before 6-12 months has passed. Best wishes!


Minneapolis Plastic Surgeon
5.0 out of 5 stars 123 reviews

Facelift with Platysmaplasty

+2

The lump under your chin can be caused by a number of things.  First, being you are only 8 weeks out the fullness under the chin may represent a fluid collection, a hematoma(collection of blood), or generalized inflammation or induration.  Fortunately, when recognized and addressed each of the above situations can resolve over time with proper minimally invasive managment.  Other reasons for fullness under the chin can be lack of fat removal when treating the neck or possibly bunching of the platysma muscle after midline platysmaplasty (although you stay  the neck bands are still present).  These are situations which will require a revisional procedure in the future.  Good Luck.....Dr. Corrado

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.5 out of 5 stars 6 reviews

It depends on a couple of things, the type of platysmaplasty and whether or not you had a hematoma afterwards

+2

Hi Nicole1031,

Good question, but it really needs more clarification in order to say whether or not this it normal after surgery or whether you need more surgery.

First, a platysmaplasty can also be a lateral platysmaplasty, where the surgeon doesn't operate on the muscle bands from the area under the chin.  If a "real platysmaplasty" AKA corset platysmaplasty or midline platysmaplasty was performed, then usually there is an incision at least 3/4" to 1 1/2" in the horizontal wrinkle under the chin.  Since no liposuction was performed under the chin, if you don't have any incision under the chin, then you didn't have a mid-line or corset platysmaplasty.

The lateral platysmaplasty, is when the surgeon lifts the platysma muscle from the sides, or "laterally."  In my experience, I could not smooth out the muscle bands enough lifting from the sides.  I find that tying the muscle bands from their separation along the middle of the neck to be much more effective.

If you do have an incision under the chin as described, then you probably did have a midline or corset platysmaplasty by your surgeon.  If this is the case, it is not uncommon to have a small blood clot or hematoma after these procedures, which appears to be a "lump" under the chin, and is not actually fat.  If this is the case, then it will likely flatten out as your body absorbs the blood clot over the months.

If a midline or corset platysmaplasty was performed, usually the surgeon can tell while operating in this area if liposuction or direct shaving of the fat needs to be performed in addition to the platysmaplasty.

In your case, it is impossible for me to say what happened to you, so you will need to depend on your own surgeon's evaluation since he or she has had the opportunity to see and examine you as well as operate on you.  Only this surgeon really knows you "inside" and "out."

Since we are hoping that you don't need any additional surgery, I'm rooting for it being simply a small residual hematoma, which just needs time to absorb.  This should flatten out without any additional surgery, especially since you said you have good skin elasticity.

Best,

Dr. Yang

George Yang, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 19 reviews

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Although it is totally normal to have some degree of swelling 8 weeks after a Facelift, the residual presence of neck bands is not.  These findings can only be evaluated by your Surgeon and should be examined.

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Swelling under chin after lower face lift

+1

Dear Lower Facelift Patient from New Jersey,
According to your description, you might have bunching of platysma band and skin, fluid collection, or generalized edema (swelling). Eight weeks post lower face lift is too soon to judge the long term outcomes. Talk to your Surgeon, or you can get a second opinion in two months if the issue persists. Good luck and good healing
 

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Lump in neck

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A lump under your chin after platysmaplasty may be the bunching of the plastysma or could be fat or could be fluid. It is hard to say without an exam.

Steven Wallach, MD
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Face and neck lift

+1

After face and neck lift it not uncommon to have lumpiness nd eneveness because of swellingand the healing process.

it all depends on what was done to the neck.

Even though you are slim you still could have excess fat under the muscle that causes full neck.

the bands are the platysma muscle seperated and causing bands which is repaired by Platysmaplasty and that involves suturing the edges of the muscle in the midline and weakining of the muscle.

Consult a BOARD CERTIFIED PLASTIC SURGEON ( AMERICAN BOARD OF PLASTIC SURGERY) for advise.

Samir Shureih, MD
Baltimore Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.