Can anything be done to fix the puckering and scarring after a neck lift with muscle suturing? Surgery was done 7 mths ago.

Question

Facelift, lower eyelid, fat grafting under the eyes, necklift w muscle tightening. I still have bags under my eyes, jowls. My surgeon says I need a relift of the cheek area w more fat grafting. The neck issue he said was caused by scar tissue and lack of fat in my neck. He never suggested anything to fix it. I do not want the relift bc he will do it in his office not the surgical center. I am going to have to live with the results on my face but I cannot live with how bad my neck looks.

Raffy Karamanoukian, MD, FACS · Answer

Plastic surgery scars require attention after surgery so that they remain cosmetically-appealing and barely noticeable. In our office, we use a protocol for scars that minimizes their activity in the 6-8 weeks after surgery. If you have late plastic surgery scars, you may also require laser and RF therapy to help reduce the longterm effects of the scarring. Keloids, hypertrophic scars, widened scars, red scars, and hyperpigmented scars all require scar modulation with topical creams followed by lasers and RF therapy. Topical skincare should be directed to a specific need, whether for pigmentation or hypertrophy and our office can guide you through the process to obtain the correct Plato’s Scar cream or Melarase cream for hypertrophy and discoloration. In terms of lasers, we would employ the vbeam laser for redness, Venus Viva RF, PRP microneedling, chemical peels, and Morpheus 8, fractional erbium, or fractional co2. All of these have their individual benefits. Most of all, we recommend you visit a solid plastic surgeon who understands surgical scar revision, laser therapy, and RF therapy for scars. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Castillo, MD · Answer

Thank you for sharing your question and photograph.  Your neck tissues are quite thin in appearance and as a result achieving a smooth result relies on maintaining as much fat as possible to have some skin pliability and motion.  Unfortunately you look to have little and would need to replace fat with some form of grafting procedure.  Hope this helps.

Jason Emer, MD · Answer

this is diffcult, you need a revision lift.  HOWEVER I owuld wait a little longer and start RF treatmetns every 2 weeks (forma or venus legacy), I would start monthly morpheus and clear and brilliant laser and I would start fillers, botox, and BBL.  energy devices will help improve the skin texture and fine wrinkles that are bothering you. the laxity and irregularities will be improved with a redraping.

if you want a dramatic change necklift/facelift, Implants and fillers will give you that. noninvasive will improve the area and facetite, threads, morpheus, and fillers can be used.  start at home dermarolling to tighten you skin, see link.

With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles.  You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and lasers for texture
2. botox, disport or xeomin to help platysmal bands
3. intensif or fractora RF microneedling for crepe skin and lifting
4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening
7. ultherapy and thermage for external tightening
8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
see an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer

Douglas L. Vander Woude, MD · Answer

Thank you for you question and photos.  As others have said, this is a difficult problem.  The skin and underlying tissues look thin in the photos.  It may be possible to improve the contour with a staged procedure.  1. Fat grafting to add volume to the subcutaneous tissue then 2. Re-elevation and re-draping of the neck.  I do not think that there is an easy / quick solution.

Brian K. Machida, MD, FACS · Answer

The only solution in this area is to re elevate the skin across the neck and do midline and lateral platysmal suturing for muscle tightening. Even then, the midline is prone to wrinkling due to tissue relaxation and the condition of your tissue.

After this is done, you might consider treatment of the skin with RF microneedling  to improve skin quality and use of fat grafting for further residual depressions.

Zoran Potparic, MD · Answer

Very difficult problem seen in patient with thin skin and minimal fat tissue underneath the skin. Botox injection to diminish muscle activity and modulate scarring, possibly very artistic placement of fat micro and nano graft to create some layer of "isolation". Do not rush, wait at least 1 year. Second and third opinion consultation is recommended. Good luck.

William Portuese, MD · Answer

Best to wait at least a year and then consider undergoing a lower face and neck lift to tighten the loose skin present

Can anything be done to fix the puckering and scarring after a neck lift with muscle suturing? Surgery was done 7 mths ago.

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