Fas Arshad, MBChB, MRCS, FRCS

I'm truly sorry to hear about the persistent discomfort you're experiencing—it’s absolutely valid to feel concerned, especially after living with these symptoms for a year. Your situation deserves to be taken seriously. A SMAS facelift involves lifting both the skin and the deeper muscular layer (the superficial musculoaponeurotic system). During this process, small sensory nerves in the face and around the ears can be stretched, repositioned, or even transected. In most patients, these nerves regenerate gradually over time, and any tightness or altered sensation typically improves within a few months. However, in a minority of cases, prolonged tightness, pulling sensations, or neuropathic pain may persist. This can feel like burning, hypersensitivity, or a deep pulling or tugging—as you’ve described. For some, the discomfort becomes chronic and significantly impacts daily life. Given that your symptoms have lasted a full year with no improvement, it would be appropriate to explore further evaluation. Here are some steps to consider: Referral to a neurologist or pain specialist: They can assess whether your symptoms are consistent with neuropathic pain, and may recommend treatments that specifically target nerve-related discomfort. Imaging: While standard imaging like MRI or ultrasound is unlikely to show "nerve damage" clearly in this context, a neurologist might recommend a nerve conduction study or refer you to a facial pain clinic where more specialised diagnostics can be done. These won’t always yield definitive answers but can help rule out other causes. Scar tissue or fibrosis: In some cases, persistent tightness may be due to internal scar formation (fibrosis) in deeper tissue planes. A consultation with an experienced facial plastic surgeon—especially one skilled in revision facelifts—could help assess this possibility. Though it’s disheartening to hear your original surgeon couldn’t offer further insight, don’t lose hope. There are avenues to explore, and patients with similar experiences have often found relief through multidisciplinary care. You deserve to feel heard, understood, and supported—and to work with specialists who take the time to investigate your symptoms with care.

Thank you for your thoughtful question, and for sharing your journey so far. It’s great to hear that you're in excellent health and leading an active lifestyle—that certainly works in your favour when considering facial and body rejuvenation procedures. As a facial plastic surgeon, I’ll focus on the facial aspect of your inquiry. Since your previous facelift was nine years ago, it’s very normal to notice some recurrence of skin laxity due to the natural aging process. What would be helpful to know is the type of facelift you previously underwent—particularly whether it involved deep plane lifting or was more superficial (e.g., skin-only or SMAS plication). This can impact both the longevity and quality of the initial results, and guide recommendations moving forward. Based on your age, the time since your last procedure, and the desire for a refreshed yet natural look, I would recommend a deep plane facelift and neck lift, which addresses not just the skin but also the deeper facial structures. This provides more comprehensive and longer-lasting results. Additionally, combining it with a keyhole (endoscopic) brow lift, upper and lower blepharoplasty, lip lift, and facial fat grafting could achieve full facial rejuvenation—targeting volume loss, sagging, and skin texture in a harmonious way.

Thank you for sharing your question and photos—it’s clear you’ve put a lot of thought into your journey, and your concerns are completely valid. It’s not uncommon for patients who’ve had chin liposuction, especially limited to the central area under the chin, to feel that the result can sometimes exaggerate squareness in the lower face if the lateral jawline isn’t also addressed. From what you've described and shown in the final photo—where you're manually lifting the skin along your jaw—it seems you're intuitively mimicking the effect of a deep plane lower face and neck lift. This surgical procedure is specifically designed to lift and reposition deeper facial structures, providing a natural and more refined contour along the jawline and lower face. It can offer the kind of permanent, structured improvement you're seeking, particularly if your goal is a more defined and feminine jaw shape. Of course, a proper in-person assessment by a qualified facial plastic surgeon is essential to determine the best approach for your unique anatomy and aesthetic goals. But based on your case, a deep plane lift is likely a strong candidate for producing the tighter, more balanced result you're envisioning. You're definitely not alone in wanting a more cohesive and elegant facial contour—and the right procedure can absolutely help you get there.

Thank you for raising this important and very valid concern. I'm truly sorry to hear that you're still experiencing significant neuropathic symptoms—such as pain, tingling, and numbness—two years after your lower facelift. Given your history of fibromyalgia, it's understandable that this ongoing discomfort is both physically and emotionally distressing. While neuropathic symptoms are an uncommon complication following a facelift, they can occur—particularly in areas where skin flaps have been raised and small sensory nerves may have been transected during surgery. In most cases, these nerves gradually regenerate and symptoms improve over time. However, in some individuals, especially those with pre-existing conditions like fibromyalgia (which can amplify pain sensitivity), this healing process may be prolonged or incomplete. If symptoms persist beyond a year and significantly affect your quality of life, it may suggest more complex nerve involvement or heightened central sensitisation. At this point, it would be reasonable to seek a referral to a neurologist or a pain management specialist. They can offer further evaluation and potentially initiate neuropathic pain management strategies. It’s also important that you feel heard and supported in your recovery. If you're finding it difficult to have open conversations with your original surgeon, you may want to consider getting a second opinion from another board-certified facial plastic or reconstructive surgeon who can assess your current condition more objectively. You absolutely deserve clarity and a treatment pathway that addresses your pain—not dismissal. Please don’t lose hope; there are still avenues to explore and support available to help you feel better.

This is a great question, and it’s not uncommon for patients in their late 30s to begin noticing signs of skin laxity—particularly after significant weight loss. First, congratulations on your incredible transformation and maintaining such a healthy weight. From what you’ve described, the laxity in your neck skin could be influenced by several factors, including genetics, natural aging, and prior weight fluctuations. While straining during heavy lifting may accentuate neck muscles, it's unlikely to be the sole cause of loose skin. In terms of treatment options, there are both conservative and surgical paths to consider: Non-surgical options like Morpheus8 (a combination of microneedling and radiofrequency) or other skin-tightening technologies may offer some degree of improvement in skin firmness. These can be good initial approaches, especially for mild laxity, but the degree of lift and long-term results tend to be modest when compared to surgical methods. For more significant and lasting improvement, especially when there’s moderate to pronounced skin laxity, a surgical neck lift—particularly a deep plane neck lift—can provide excellent, natural-looking results. When performed meticulously, with careful attention to skin closure and scar care, this procedure can achieve a refreshed and youthful appearance with minimal visible signs of surgery. Of course, the most appropriate option can only be determined after a proper clinical examination of your neck and facial anatomy. But based on your age, weight history, and concerns, you're at a point where it's completely reasonable to start exploring these options—whether conservative or surgical.