Disappointed with results of SMAS lower face/neck lift. Can my neck be improved? (photos)

Question

I am three months post surgery from a SMAS lower facelift. My neck had very little improvement and I expected a better result. As time goes on, my neck skin gets looser. I took very good care of myself post surgery. I am not overweight or a smoker. I am very disappointed. Can my neck be improved?

John Michael Thomassen, MD · Answer

Dissection from one side of the face to the other via the submental area should correct any skin irregularities or bands.  Sometimes this requires pretty wide skin undermining to properly correct the neck.

James Bonaparte, MD, MSc, FRCSC · Answer

The Neck portion of the facelift is often the most difficult aspect of the procedure. If not performed properly, patients can be disappointed, as you are. The key is whether or not two things were performed, a good snug pull on the deep neck tissues up behind the ears and a good snug treatment of the neck in the mid line (under your chin and down towards the Adam's Apple). Ask your surgeon what approach he/she used and see if any improvements can be expected. James Bonaparte, MD, MSc, FRCSCFacial Cosmetic SurgeryOttawa, Ontario, Canada

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about SMAS facelift.Did you have an incision underneath your chin in addition to incisions by the ears?  Often, aggressive work centrally needs to be done to address the under-chin area and central platysmal bands.You may discuss possible facelift revision with your plastic surgeon.  If you have it redone, I would wait about one year.I hope this helps.

John J. O'Brien, MD · Answer

Hello, and thank you for your request. I am sorry to hear that you're still having problems following your procedure. It is difficult based upon the pictures were shown to see her overall result. I do believe the photo exposure seems to be different and you do have some skin aging changes that may be improved with a good medical aesthetician. I would recommend to follow up with your treating surgeon to discuss all of these findings. Best a block.

Marc DuPéré, MD · Answer

Thank you for your picture.I agree that your neck has been improved yet not as good as you might have expected.Was the front part of the neck opened and the muscle repair?  There are controversies in opening or not the front of the neck but I open most anterior necks in my practice.  If it was not done, perhaps it could be contemplated; it is a simple procedure on itself and can be done under local anesthesia and IV sedation.It would be good to have the OR note prior to recommending a treatment but if the anterior neck was already done, you might need another SMAS-skin correction.Best regards.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Many thanks for submitting your question and photos.It would be hugely beneficial to know the exact details of your surgery to establish if you had tightening of the neck muscle as part of your neck lift procedure.It should be entirely possible to improve your neck and revision surgery should be considered at around six months. I would suggest seeing your original surgeon if you haven't already to seek advise on how to proceed.Many thanks.

Paul W. Papillion, MD · Answer

Hello, I can see your area of concern clearly in your pictures. The details of your surgery would help to know exactly what was done. ...one question is whether you had a "mini" faceneck lift where a limited dissection under the neck is performed as oppose to a full dissection freeing up and addressing all of your neck skin. Best advice is too discuss this with your surgeon and if they have no acceptable explanation it would not hurt to seek a second opinion.

Tariq Ahmad, MBBChir, FRCS(Plast) · Answer

Thank you for your question.

I have to say that a perfect result after face lifting under the neck is not always easy to achieve; I normally discuss this in some depth with my patients. The results can be improved but then a more aggressive neck lifting procedure is required or even a formal platysmaplasty to deal with the bowstringing muscle bands in the neck.

If still present after surgery there are a number of options available including Botox, minimal or no incision division of the bands by sutural techniques to divide the muscle bands or more formal open correction of the muscle bands.

I hope that was useful information for you.

Best wishes

Gustavo A. Diaz, MD · Answer

Hi ARSatty,On you post surgery pictures you wrote that it is 3 months after mini-facelift. Mini-facelifts are not intended to address aggressively the neck area due to the limited approach that the use. Your procedure can be revised in about 12 months after the original surgery and converted to a facelift with incisions behind your ear and hairline to treat more aggressively your neck. Also at that time your platysmaplasty can be revised in order to give your a tighter neck.Hope this helps,Dr. Gus Diaz

Steven Wallach, MD · Answer

Unless the neck was treated directly, a SMAS facelift will have very little effect . Sometimes a flap of SMAS is rotated to the mastoid region.

Disappointed with results of SMAS lower face/neck lift. Can my neck be improved? (photos)

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