Does this look like a cobra neck or something else? (Photos)

Question

I had a neck lift 7 months ago. My neck looks like I have long, heavy bands on each side. PS told me to be patient as they will smooth out over time. The PS is lasering my neck this week in hoping it will build cologen. I am unhappy with the look. What do you think happened with the surgery? What is my next step?

Jennifer Boll, MD · Answer

I am sorry that you are so unhappy. Overall your neck looks very good but I definitely see the residual platysmal banding that bothers you. This can be improved with a central neck plication that can be performed in the office setting. Botox can also be utilized to improve the banding but this is more temporary. Good luck!

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

Thank you for your questions and pictures.  In your pictures it seems that you need tightening of the platysma muscle (also known as platysmaplasty) will require a small incision under the chin away from direct view to gain access to the front edge of the muscles on the neck; they are sutured together with permanent stitches. The muscles of the neck are the foundations and building blocks of the neck and are fundamental to achieving a tight and toned result.  Please make sure you find a reputable and qualified plastic surgeon who can assess you properly to give you a realistic idea of what outcome you can achieve.  All The Best

Kenneth D. Steinsapir, MD · Answer

This is not a cobra head deformity.  That occurs when surgeons aggressive remove subplatysmal fat from the central neck.  These are simply platysmal bands that did not get addressed with your facelift. Did your surgeon perform central neck work?  Some do not.  This is best addressed with a midline plastysmaplasty.  That can be done as an isolated procedure or as part of a more extensive revisional facelift.  Lasering the neck skin is not fixing this.  While saying building collagen may sound good, it will not in anyway address your concerns.

Vaishali B. Doolabh, MD, FACS · Answer

Hi KMiller58.  It must be difficult to be unhappy after your procedure. Without knowing the techniques used in the neck lift, it is hard to say for sure "what happened".  If your bands are residual muscle bands, then a small incision under your chin and suturing them will improve them.  If the bands are extra skin, that can also be improved with the incision under the chin.  If you already have the chin incision and the ones around the ears, then the skin is thin and lax, and treatments to increase the collagen will help.  I have had the best results with Profound radiofrequency microneedling to tighten skin.  It doesn't appear to be fat so I wouldn't consider the many treatments like Kybella, liposuction, coolsculpting etc.  You might consider a second opinion from another ABPS certified Plastic surgeon before undergoing additional treatment.  Good luck!

Jason Emer, MD · Answer

To improve your final results, I recommend a combination approach with thermage/venus legacy and Kybella/Ultherapy. I recommend getting a formal consultation with an expert. Best, Dr. Emer

Marcelo Antunes, MD, FACS · Answer

Thank you for your question.
Looking at the pictures this does not look like a cobra neck deformity. It seems this is either loose skin or platysma muscle. 
Laser/Ultherapy can help in case this is skin and you could try botox injections in case these are muscle bands.
If that fails to improve you may want to consider a small revision procedure. I suggest you discuss all option with your surgeon. Good luck!

Kevin Sadati, DO · Answer

It appears that your platysma bands are loose under your chin area.  You may benefit from botox injection to the area and laser treatment to tighten the skin. Follow you PS advise.

Laxmeesh Mike Nayak, MD · Answer

It is possible to have some degree of residual/recurrent banding after neck lift surgery, even if the muscles were directly repaired during the surgery.Unfortunately, the only reliable way to treat them further is to do a revision neck lift, which is not a minor undertaking. If bands are mild, and improvement has been great, sometimes it is appropriate to accept them rather than pursue further surgery.

Jenifer L. Henderson, MD · Answer

Hello.  You do not have a cobra deformity, what you have is called platysma banding.  The platysma muscles separate in the midline  and move anteriorly as we age.   The bands likely existed prior to your surgery but were camouflaged by fat above the muscle and under the skin.  When the fat is removed during a necklift/liposuction, the bands become visible.  The bands that you are seeing will not be corrected with skin resurfacing but can be corrected by suturing the bands together in the midline or can be diminished by using Botox along the anterior and posterior borders of the bands.  Hope that helps!  Good luck!

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