Facelift/necklift, so many "after" photos show a small pouch of hanging skin under chin. Why is that?

In patients with very heavy necks there will be a bit of fallback after the operation. In patients with lesser problems one would expect the result to be excellent. Make sure you see the magnitude of the problem preoperatively before judging the final results.

Thank you for an interesting question.  Not knowing what photos you've looked at, it would be hard for me to give you exact reason why there might be some fulness under the chin on the pictures.  One possible reason would be residual swelling.  Some swelling is normally present after every facelift.  This swelling usually goes away pretty quickly in the cheek area and around the jawline.  However, residual fluid has a tendency to build up under the chin, causing this area to appear a bit puffy.  Most doctors take "after" photos at 2-3 month after the surgery.  At this time some fluid is still remaining under the chin and some (very slight) puffiness may appear on the postop pictures.  This residual swelling is mostly gone by 6-9 mont after the facelift.Best of luck with your facelift!Dr. Konstantin 

Generally speaking, it can take 6 to 12 months to completely heal after surgery. Please keep in touch with your surgeon or his/her clinical team to discuss your ongoing concerns.

The importance of examining before and after photos from different facelift surgeon lies in learning what the procedure in this surgeon's hands can do and what it cannot do. If you feel that the results of other patients would not satisfy you, then this particular surgeon may not be the best choice for you. In addition, accepting limitiations associated with every aesthetic facial surgery is important before undergoing this procedure.

as the other surgeons answered, there are several possible reasons for this.  Posted swelling can stretch the skin somewhat and since most patients having a facelift are older, their skin doesn't bounce back as much after swelling and some skin laxity is formed.  The neck laxity tends to be the one more difficult to get perfect results in.

This is a really important question to ask and receive an answer.  The simple truth is that no matter how tight a surgeon pulls, there is always some relaxation that occurs.  Sometimes minimal.  Sometimes more that one wants to see.  The reason why this happens is because facelift patients have loose aging skin with loss of elasticity.  That is why one desires correction. There are several excellent facelift techniques to improve the jawline and the neck but there is no surgical procedure to give you or anyone else tight, youthful skin again.  This is why you and every other person contemplating this procedure must be realistic in regards to outcome.    

There are actually quite a few reasons that you may see this neck skin residual.  One is that the patient preoperatively might have had quite a lot of loose, inelastic skin to start.  Even with the best surgeon, technique, and post op course there might be residual skin after a facelift.  It's just too much to ask of the surgery overall.  Reason two is that a patient had appropriate surgery but just swelled a great deal post op, and when the swelling resolved the skin could not redrape perfectly smoothly and ended up with skin excess.  Similar to this is the patient with really loose non compliant skin that started out nice and tight post op but just relaxed after surgery to the point of a little submental sag.I think the most common reason, however, is that the sub-SMAS portion of the surgery is not released enough (meaning minilifts or MACS lifts or named nationally advertised lifts), and therefore tends to settle back where it started.  Or that the surgeon redirected the tissue in a vector too posterior instead of superior, resulting in an incomplete repositioning of the platysmal muscle.  The result of that posterior vector is residual submental laxity.

The bottom line answer to your question is that you are right that often times there is a small amount of loose skin under the chin after this procedure. This can occur due to relaxation of the neck skin and or muscles. What I typically tell my patients is to expect that after six months or a year that some relaxation can occur, not in every patient, but that if/or when this does occur, we typically do a very minor procedure under local anesthesia to remove that residual skin and clean up the jaw line. That procedure typically takes 15 to 30 minutes with minimal recovery time and can enhance the results. Good luck in your area.

The results of face neck lift very between patients. The goal is to improve the neck contour. The best improvement that sometimes can be made results in a subtle contour the deformity. I would recommend that you visit multiple  plastic surgeons to find a surgeon that produces results that are more in line with your thinking.

The excess skin may be due to residual swelling, residual fat
in the area, or due to the location of the incision. In many people there is a
fold below the chin called the submental crease. Many surgeons place an
incision within this crease to gain access to the front of the neck. The
resulting scar from the incision can cause the crease to become deeper and more
prominent. As the crease becomes deeper, the chin area in front of the incision
can appear more full. This may be the excess skin that you’re noticing.
Sometimes surgeons will place their incision behind the crease to prevent accentuating
this natural wrinkle.