Laser lipo; My neck looks worse now then before the lipo. Is there anything that can correct this for me? (Photo)

Botox to  the neck(platysma ) muscle is often helpful to reduce the mid line fullness in some patients. A complete  physical exam  is essential to decide  if this is appropriate for you. If the neck muscles are actually too loose, then a neck lift  with a platysmaplasty is probably the best option. Best regards, Prashant Soni M.D.

Thank you for your question. You submitted a single photo, stating you underwent a laser lipo of the neck approximately a year ago, and feel your neck actually looks worse than before, so you are asking about potential options to help the neck look better.

I can share with you my approach to evaluating people like yourself who come into my practice with exactly the same issue. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon  practicing in Manhattan and Long Island for over 20 years. I specialize in facial aging rejuvenation procedures including liposuction, and laser-assisted face and neck lifting so I’m very familiar with this type of scenario.



We first determine if there is excess fat, excess skin, and if there is any laxity of the underlying muscle called the platysma muscle and the bands related to the muscle. I also look at what the neck looks like in the context of the rest of the face, and assess for any facial descent





There are different scenarios where people like you end up in this place, and I’m seeing it a little more often, and not just because of laser-assisted lipo. There are other options in the market that supposedly help people avoid certain surgical procedures. Also, a lot of people are treating fat as the enemy, or try to tighten the skin without treating anything else. You are certainly in good company of people who are frustrated with the results of procedures that didn’t turn out the way they expected.





One of the major issues I’ve seen over many years is the perception that fat under the skin is a bad thing. Particularly, people come who have extra skin ask me, “Can you just lipo this area?” Everyone thinks they have too much fat. A proper diagnosis is the take home message that even if there is a little extra fat, how much difference will the procedure make? The point of laser versus lipo alone was that the hope was laser would melt some of the fat and would make it a little easier to remove. Technically speaking, taking fat from under the chin is not difficult, but the major benefit is the retraction of the skin. This  means if you have some loosening of the skin, maybe it will retract upward. The problem is you can’t really accurately predict how much someone will retract. With laser procedures, you would get more retraction, but would that be significant enough? Even though a lot of people believe strongly in this technology, it is always about patient selection and who really can benefit from it.





The situation like yours , and not specifically to you, but it could be the scenario where someone recommends you undergo face lifting, or face and neck lifting, or just neck lifting alone, and people will often say, “Well, I’m not ready for that yet.”





And the well-meaning doctor then says, “We will do something like laser lipo.”





It is clear that you are dealing with some skin laxity, so a proper evaluation on how to manage that will guide you to the next step. Typically, it’s some variation of a facelift, face and neck lift, or even a limited neck lift. All these procedures have their pros and cons, and I think you really have to get a more comprehensive evaluation. I don’t think that non-surgical skin tightening, whether it is radiofrequency or Nd:YAG laser, will be adequate. Those technologies have some benefit, but really I think it is more a qualitative improvement and not a quantitative improvement.





I think understanding clearly that fat is not the only problem you’re dealing with, but also skin laxity and skin quality, and there many options to address those. In our practice, when I do facelift, face and neck lift for patients who are really concerned about the scenario of having these types of procedures, I basically reassure them these procedures are done under local anesthesia with LITE™ sedation. Often they are intimidated or fearful about going under general anesthesia, be we can do these procedures with minimal trauma. I use a lot of different techniques to expedite the healing process and deliver the best result  possible. You may benefit from some tissue regenerative technologies such as platelet-rich plasma (PRP) to stimulate collagen in the skin, which can be used concurrently.





There are more than a few ways to do this, and also in a way that is comfortable and safe. We do our procedures like this in our facilities in our office certified by the Joint Commission, the same organization that certifies hospitals, surgery centers, making sure we meet very stringent standards for safety, personnel, sterility, etc. I think ultimately you need to meet with qualified and experienced cosmetic surgeons who can guide you on what kind of outcome best suits you, and how to achieve that in the safest and most predictable way. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

Thank you for your question. While time is a great agent for healing, please ensure that you are following your surgeon's recovery instructions. Additional remedies include fillers and revision surgeries. You would benefit from a consultation with your surgeon to discuss the outcome. Always consult with a board certified facial plastic surgeon.

Best wishes,