I Have Draping Under My Chin 1 Year Post-op Neck & Facelift, What Should I Do?

Question

I noticed some draping under the chin coming down from the scar within a few months after surgery. From my profile I think I look like I have jowling. Just not a perfect jawline. My plastic surgeon has told me this is due to salivary glands that are more visible now. He told me that there is not much that can be done but is consulting with an ENT specialist for suggestions. I wanted him to tighten the draping but he said it would look the same in 6 months. Any suggestions? see pictures

Elliot M. Heller, MD · Answer

From you picture it appears that there is excess skin present laterally. Re-lifting the skin flap and re-drapping should help correct this problem

Lawrence Kass, MD · Answer

I think you are both right! I think that you do have prominent salivary glands and that not too much can be done about this. But you also do appear to have excess skin with jowling and might benefit from further tightening and skin excision. Speak to your surgeon; he may be willing to help you to win your satisfaction. Good luck!

Anthony Corrado, DO · Answer

I have reviewed your pictures. Yes, it is true that ptosis ("droopiness") of the submandibular salivary glands can cause fullness in the submental area (under the chin). There are procedures that can correct this ptosis to a degree. Although, I do not think that the above issue is your problem. Seeking an ENT I do not think is an answer, as I cannot believe any ENT surgeon will remove the salivary glands for cosmetic purposes. It appears from pictures alone that you continue to display skin laxity in the neck and jowl area. It also appears that the skin in the submental area did not re drape smoothly after your surgery. If you are at least 1 year out from surgery it is not unreasonable to have a revision of the lower face and neck lift, via the original incision lines, to better re drape and tighten the lower face and neck. I perform a large amount of face/neck lifts in my practice, and feel that you will be able to undergo a revision safely. Good Luck.... Dr. Corrado

Todd C. Miller, MD · Answer

From you pictures it does not appear that submandibular (salivary gand) ptosis (drooping) is your primary issue.  It appears that your neck remains tight in the midline but you have some drooping laterally with some concavity in the midline as well. The concavity in the midline may have been a result of removal of too much fat however you did not indicate whether or nor you had liposuction and you didn't provide your before pictures so I'm speculating.

	Removal of the salivary glands would not likely fix your problem and I agree with other opinions on this board that I do no know of any ENT surgeons that would remove the submandibular glands for cosmetic reasons.

	I think that you could have some improvement from a revision facelift and necklift with removal of excess skin, reinforced anchoring of the platysma (neck) muscle, and the SMAS (face muscles). Fat grafting may provide some improved contouring in the midline of the neck as well. I hope this helps.

Wilfred Brown, MD · Answer

I have reviewed your photos. I believe that you have several issues. Firstly I feel that you do not have ptotic submandibular glands, and resecting the superficial lobe would not be warranted. Secondly, you have some residual jowl fat - this can be addressed with conservative liposuction, and finally I feel that the surgeon may have been overzealous with his/ her fat resection in the subcutaneous plane of the neck and this is often very difficult to correct. I suggest that you contact your surgeon and discuss your concerns.

Philip Young, MD · Answer

You could benefit from a neck revision to tighten the muscle in your neck more and another redraping of your neck skin. The bunching may still occur at which point I would fat graft the area to improve it.  I have a special approach where I have done the worst type skin bunching. Based on your pictures. It doesn't look like glands as the cause. Sometimes scarring underneath can cause the skin to bunch. Grafting fat there can improve the way the skin lays if you don't want to repeat the neck lift again.

	Thanks Dr. Young

Mohsen Tavoussi, MD, DO · Answer

Although the submandibular glands can be more prominant in some patients after a neck lift, what I can see from your photograph is over tightening of the platysma and under tightening of the skin laterally. A revision should correct these.

Albert Dabbah, MD · Answer

Salivary glands can be more prominent after a face and neck lift. They are usually hidden by fat and or excess skin. This may be part of your issue but it appears you have excess skin in the neck area and below your jawline. Speak to your plastic surgeon again and see if this can be revised. Also consider seeking a second opinion so another plastic surgeon can evaluate you and render an opinion as to wether this can be improved with additional surgery.

Francis R. Palmer, III, MD (retired) · Answer

The excess loose neck skin would require dissection to free up the skin and removal through an incision placed under your chin similar to the one you had with your original Face Lift and Neck Lift. This would be preferred over a revision Full Neck Lift that would take 3-4 hours, require large incisions and could place the neck skin in jeopardy, of healing because of the previous Neck Lift a year ago.

I Have Draping Under My Chin 1 Year Post-op Neck & Facelift, What Should I Do?

Answers (9)