I had a SMAS lift in May. I think my PS did an excellent job, as overall, I have been very pleased with the result. However, in the last month, I have noticed my wattle is returning. Right at my throat - I have that line of skin that stretches under my chin back. So much so, that I can flick the loose skin with a finger. I know he tightened me as much as possible during sx, so this clearly is my skin settling back in. What is my best option and when would you suggest any revision be done?
Best Solution for Redundant Lax Neck Skin After SMAS Lift?
Doctor Answers (13)
Lax neck skin following facelift
Hello and thank you for the question.
Following a facelift procedure there is always an element of skin laxity that returns and can be expected several months after the face has reached a stable state.
Facelift procedures, while designed to reposition the internal soft-tissue structures and thus produce a more youthful and refreshed post-operative appearance, do not in themselves address the actual skin/soft-tissue quality which becomes compromised during the aging process due to both intrinsic factors ( large weight fluctuations, chronic illness, genetic predisposition ),and environmental factors such as photo-aging and smoking, among others.
Subsequently, in my practice,I offer concomitant treatments aimed at fortifying the skin and soft-tissue in order to produce improved results. These modalities include both topical and oral nutriceauticals, derma-roller therapy, and fractionated laser resurfacing, all aimed at improving the integrity of the skin.
Glenn Vallecillos, M.D., F.A.C.S.
Loose neck skin after Facelift
All patients experience some skin looseness after facelift surgery as the swelling goes down. If however there is a fair amount of skin that hangs down as sounds in your case, you very well may need to have some form of neck lift procedure done.
Best to have your Surgeon examine you and see what needs to be done - it might be s simple as removing some skin under your chin or may be more involved in that the neck muscles may need tightening and extra skin needs to be removed (usually from behind the ear).
In some cases there are no neck issues and the Surgeon can remove your extra skin by using the top part of your facelift incisions to lift up and tighten the are under your chin.
Any which way a visit with your Surgeon to discuss will be of great help to you.
Recurring Neck Laxity After SMAS Lift
The SMAS facelift is an excellent technique for repositioning the facial fat and supporting the tissues of the neck. The skin loses its elasticity over time and some of that inelastic skin is removed with the facelift. However there is a limit to how much skin can be removed because the excess tension on the skin may compromise the blood supply to the skin. It is not uncommon for there to be some rebound laxity of the skin especially in the neck. For a small amount of laxity you may get some improvement with a fractionated CO2 laser treatment of the neck. For more substantial laxity you may need a revision of the neck lift. I would wait at least a year prior to performing any further surgery.
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Treatment for sagging skin after SMAS facelift
If laxity is minimal, you may want to consider Ultherapy. Ultherapy is a great non-surgical way to treat minor sagging skin. If the sagging is significant, then you may need a limited revision facelift. Discuss this with your plastic surgeon as he can asses your situation.
Redundant Lax Neck Skin after SMAS Lift
A facelift addresses the jowl and neck by tightening the underlying SMAS and platysma. The neck improvement depends on how extensive your surgeon addtiionally addressed this area. For example was a separate incision made under your neck and a playtysmaplasty done?Was there extensive undermining of the skin in the area of the "turkey waddle", etc. Each of these maneuvers improves the result if applicable to you.
Also realize that in most cases after the swelling resolves afterwards together with the natural loss of elasticity in most patients, subsequent skin relaxation to a degree will be seen in some patients.Three to six months after facelift surgery is when this usually is apparent. This can be corrected if desired in most cases
Loose skin after a facelift
It is not uncommon for the central skin of the neck to loosen after a facelift as the further you are from the incisions, the faster the problem returns. It might need a neck procedure to tighten the skin a bit more.
Residual skin excess after face lift
You likely had a platysmaplasty or a neck tightening procedure along with the face lift which sometimes can exagerate the skin excess. Sometimes the skin tightens alittle bid as scar tissue matures but if it persists or worsens there are several options. Nonsurgical options are Fractional CO2 LASER resurfacing which can improve skin texture and tightness, radiofrequency treatment like Thermage or Triactive which will require multiple treatments and results may be temporary. I find that excision of skin under the chin can cause "dog ears' along the sides of the chin. T-neck or Z-plasty are good options for men with significant anterior neck skin excess but I believe they result in a scar that is too visible for most women's comfort. Lastly, the best option may be to redrape the neck skin but reopening the incision behind the ears and redraping the skin and excesing the skin excess from behind the ears. I find that when the skin has been completely elevated off the underlying myscle or the platysma muscle was not closed well in the middle before suspending it laterally, this type of skin laxity can occur. I recommend discussing this with your PS and reviewing your options.
Recurrent excess skin after a facelift
It's great that you're pleased with the results of your facelift. Small revisions can be done around 8-12 months after the initial surgery and all of the swelling has resolved.
Recurrent looseness after facelifting may be addressed 3 ways
If you looseness is very mild, and your improvement great overall, I'd recommend leaving well enough alone!
More moderate recurrent looseness, concentrated at the midline and "high up" is often best addressed with a direct excsion of skin, plus or minus T- or Z-plasty.
Significant recurrent looseness is best addressed with a full revision necklift.
I would discuss these options with your surgeon, as you seem to have a good relatinoship with him/her. If you would like a second opinion, seek out an experienced facial plastic expert.
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.