Request for a second opinion: Horizontal bands across my neck after facelift and neck lipo, is this normal? (Photos)

Question

I know it's still early, and I have talked with my surgeon, but I would just like another opinion. I'm 3 weeks out from a facelift and neck lipo. I am still swollen and very tight, understandably, but I'm mostly concerned with what I call the "bicycle tire" around my neck. My surgeon advised that I do some massage and just be patient. But when I look online I mostly see platysmal bands, not these horizontal lumps. Is this normal?

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

The swelling and lumpiness in your neck appears to be in the lower part of the pocket of dissection (undermining) that your Surgeon has used to improve the contour of the neck. Most likely, it is driven by the fluid that has collected with gravity, and sometimes it follows the contours of where the drains have been placed.
At this stage, it is common for the contours to show irregularities in particular if there has been some more bruising. There seems to be more significant early bruising on the left side of the jawline and it appears associated with more substantial swelling in the neck.
It is very likely to look great at 3 to 6 months and although the waiting game is difficult for everybody, aggressive intervention at this stage with steroid injections is more likely to be problematic than helpful in particular in someone with relatively soft skin.
There are a number of products that have been shown to reduce the swelling quicker like Arnica Montana cream, and treatments like manual lymphatic drainage or low power laser which is used by physiotherapists.
Even if you do nothing about it the healing process will deal with it at reasonably good rate.

Ben Lee, MD · Answer

Thank you for your question. At three weeks, it is still possible to have moderate swelling after a facelift (or any surgery for that matter). Remember, our timeline for judging results is several months. I would strongly urge you to stay in contact with your surgeon and have faith in him/her. Remember, they have been through the recovery process hundreds if not thousands of times, and have seen any number of variations in the recovery process.

Edwin F. Williams, III, MD · Answer

You can certainly get neck irregularities after surgery which is often the result of immature scar bands. I would agree with your surgeon about massages at this point as these almost always resolve over time. When there are persistent neck irregularities I usually see it occur in people who smoke, otherwise they tend to resolve. Hang in there!

Scott C. Lindsay, DO · Answer

Thanks for your question! I agree that you just need to be patient. It looks like you still have significant swelling which should subside with time. Continue to wear compression and follow the instructions of your surgeon! Good luck!

John Bitner, MD · Answer

Thank you for the question and photos.  Your neck and jowls look amazing!!  It is nice to show the before photo.  Areas of swelling and irregularity in the neck after a procedure like this is common and should go away with time.  The photo angles make it a little difficult to compare, but it looks a bit better even from the second picture (probably about a week or 10 days out) to the third and fourth picture.  Keep being patient, I think it will get there.

Andrew Campbell, MD · Answer

Your photos look like you have residual swelling low in the neck. .The swelling descends with gravity. The lower neck can be the last area to resolve. Be patient. This will almost certainly resolve on its own.

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Andrew Campbell, M.D.
Facial Rejuvenation Specialist
Quintessa

Richard G. Schwartz, MD · Answer

There can be several causes for what your photos show.  These could include localized areas of soft tissue swelling, small collections of blood, effect of internal stitches placed across the neck to help tighten muscles, and even the effect of cutting muscles so they retract to the side more increasing the neck angle.  Obviously, I don't know your surgeon's exact technique, but the bottom line is it is very early in the healing process, and most likely, with continued healing, soft tissue massage, lymphatic treatments, and the natural relaxation of tissue everything will smooth out.

Ronald J. Edelson, MD · Answer

I definitely see that neck ridge you mention. It should improve with time as it is probably swelling. If it doesn’t go away after several
Months a little liposuction in that area could easily be done. But for now  just wait. I agree with the recommendation to massage

Jane M. Rowley, MD · Answer

It is too early to make any calls about final results.  Swelling lasts at least 2 months, and scar tissue can take 4-6 months to soften up.  So the final results, contour etc. takes at least 6 months to determine.  Its hard to be patient, especially on your face, but it will get better.  Good luck, Jane.

Robert M. Tornambe, MD · Answer

I completely understand your concerns, however it is extremely early in your face lift recovery journey to be concerned. It appears from your photo that you have normal, well-defined swelling of the neck that should resolve with time and massage. Try to stay patient and confident and follow up with your board-certified plastic surgeon as needed. Good luck.