I am updating my question with photos. What can I do about my neck?

4 months after lower facelift and my neck is not pretty. At first it was and I was very happy. My surgeon gives me no support post op. I will upload photos from 3 weeks after and photos of today ( 4 months) what should I do?
This is a follow-up to an earlier question, which can be viewed by clicking here.

Doctor Answers 17

Banding in the neck after a facelift

It looks like you have some residual banding in the neck. This may have been masked by swelling in the initial healing process. 4 months is still a bit early in the healing process to make a determination on the final outcome. I would give it a couple more months and, if it persists, you may need to have a revision procedure to re-tighten the platysma muscle and release the muscle. Make sure to stay in contact and work with your surgeon.


Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 reviews

Falling necks after 2-4 months typically will happen after a lower facelift without a proper necklift

Hi Dabuji,

A lower facelift is essentially a mini-facelift.  There are incisions around the front and back of the ears.  The deeper tissues called the SMAS are tightened from the sides of the face, but very little if anything is performed under the chin.  The lifting from the sides can make the neck look good initially, but as the SMAS tightening relaxes, the neck will fall.  Your last photo does not appear to have any incision under the chin, or perhaps only liposuction was performed in which case the incision may have been closed with a single stitch.

Some surgeons will pair some liposuction under the chin with a mini-facelift or lower facelift when the patient has a single area of sagging skin under their chin AKA turkey neck or wattle.  This single area of sagging neck skin is not what it appears to be.  It is not just skin and fat, but there is a component of platysma muscle bands or muscle cords within this wattle.  This is why it is important to perform a necklift along with a lower facelift.  A necklift is composed of some liposuction if there is excess fat, but in your case your neck already looks very thin, so I may not perform any liposuction to not overly remove fat from the skin under your chin, and tighten the platysma muscle under the chin in a procedure called a platysmaplasty.  Any fat under the platysma muscle is fair game, but the fat directly under the skin (subcutaneous fat) is more precious and helpful in minimizing crepiness of the neck skin.

To improve the vertical bands on your neck and loose skin would require horizontal incision under the chin where the chin wrinkle is located, approximately 1/2"-3/4" long.  This gives access to the vertical muscle cords under the chins which need to be sewn together as a corset platysmaplasty.  Then to further smooth out the skin under the chin, the incision around the front and back of the ears ideally would need to be reopened to further smooth out the extra skin through those incisions.

You should talk to your surgeon and ask if a platysmaplasty was performed and if he or she is able to perform a platysmaplasty.  Some surgeons perform a wide variety of plastic surgery procedures and may not offer a platysmaplasty.  Keep the lines of communication open, and most surgeons are more than will to take care of their patients, especially if they know that they are posting their reviews and questions on Realself.

Best,

Dr. Yang

P.S. There is a new feature on Realself, which is the "Follow" button. It is similar to the "Like" button on Facebook. If you like my response or any of the doctor responses while you research on Realself, you should "Follow" them. You will get email updates, when the doctors you follow post any new answers to questions, post new photos, or have any new reviews.

George Yang, MD
New York Facial Plastic Surgeon
4.8 out of 5 stars 31 reviews

Facelift and neck issue

It looks like the skin has relapsed a bit. Is it swollen? is the tissue soft?  Hard to say in a photo. Usually you have to give it a full 6 months minimum before considering a touch-up. This may require skin excision only, hard to say without an exam.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

You should expect a better result from a facelift regarding your neck.

The neck is generally one area the facelift does exceptionally well particularly and thin people. It looks as though the platysma muscles need to be re-repaired

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Neck bands such as these are difficult to correct

Neck bands such as these are difficult to correct, and often recur after a few months.  This is one of the most difficult areas to treat in face/neck lift procedure.  Aside from directly trimming the excess skin, there may not be much to give you a fully tightened skin look

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 427 reviews

Lower facelift

The ultimate answer would require in person examination to assess more fully what we see on the photo.  The term facelift (lower or otherwise) gives very little information on what was done at the time of surgery.  It would be useful to know if you just had incisions around the ear or did you also have one under your chin.  Additionally, it is important to know what was done in the neck; in other words did they do liposuction, directly cut out fat, plicate the muscle centrally or do nothing at all centrally and just pull from the back.  Knowing the answer to the above questions as well as examination will help in determining whether this just requires excision of redundant skin or does the underlying muscle and fat need to be addressed.

In general, after surgery the swelling present in the healing process can make things look tighter and smoother.  As swelling recedes and the tissues relax it is not uncommon to see some return of the laxity in the central neck skin.  In your case it looks like there was too much recurrence of central neck skin laxity.  If it is just skin laxity then there are two options, revising the surgery to pull more of the skin laterally, or as would be my preference, directly excising the excess skin through a discrete incision in the central neck that will give improved contour and tightening.  

Robert Glasgold, MD, FACS
East Brunswick Facial Plastic Surgeon
5.0 out of 5 stars 29 reviews

Neck Changes after a facelift and necklift

Usually a lower facelift is not a minimal procedure.  I suspect you did have a standard procedure.   I would like to see your pre operative photos.  Neck skin that is very wrinkled will stay wrinkled and look better after a facelift.....but still wrinkled.  I would like to see your pre operative photos.   I would like to see profile and 3/4 photos.   It may be  all that can be done,  was done.  Possibly not.  Nothing is simple.    Yours is a very complex situation requiring a complex analysis.    My Best,  Dr C

Platsyma bands

The neck has dropped and you have platysma bands present. This can happen after a facelift and this area is difficult to treat. It depends on what you had done and how you started out. botox can help in these bands and is the least invasive. Directly repositioning the platysma may be required long term via an anterior neck incision. Best to chat to your PS for advice

Gary L. Ross, MBChB, FRCS
Manchester Plastic Surgeon
5.0 out of 5 stars 142 reviews

Neck banding after a facelift

Neck results after a face and neck lift are the least predictable of the two procedures. I would wait a full 6-9 months before considering any type of revision, even better would be to wait 12months. Then a neck lift can be done, looks like you could need a combination of a platysmaplaty and removal of excess skin. Do you have before pictures  that we could compare your result with ?

Dilip D. Madnani, MD, FACS
New York Facial Plastic Surgeon
4.9 out of 5 stars 79 reviews

Recurrent neck banding after facelift

Recurrent "banding" after a facelift is extremely common in anyone who had significant neck laxity prior to the face/necklift.  The time course photos you show are in fact typical. It is really just a question of expectation management, if your surgeon discusses this and even better shows long term follow up photos and discusses it before the surgery than you would not be dissatisfied at this time.  

I have done many different operations to address or prevent this including suture suspension gortex suspension, platysmaplasty, revision platysmaplasty, revision skin excision and directly cutting out the skin under the neck. None of them are completely satisfactory in either preventing or treating other than directly cutting out the skin. 

Realistic expectations from patients and by doctors would go a long way towards overall higher patient satisfaction.  I have had patients fly to so called world famous surgeons for revision neck lifts and the skin was pulled very tight ultimately leading to no significant long term improvement but some pretty nasty hypertrophic scars from the tension that I have had to deal with.

Mark Glasgold, MD
Highland Park Facial Plastic Surgeon
4.5 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.