Deep plane neck and facelift 6 months ago, I’ve been left with hollowing and sagging on each side. How can this be fixed?

Question

I had a deep plane neck and facelift 6 mos. ago. I am 51 and had significant neck laxity due to weight loss. The turkey neck was removed, but I’ve been left with hollowing and sagging on each side. I posted previously, but some of my pictures were omitted. I’m reposting with additional photos of the issue. My surgeon wants to do Forma and CoolPeel which I’m reluctant to do. I was told by another surgeon that revision surgery would be too risky because I had deep plane. How can this be fixed?

J. Timothy Katzen, MD, FACS · Answer

Thank you for your question regarding whether a deep plane neck and face lift performed six months ago can be revised because you are left with hollowing and sagging on each side.
Thank you for your pictures. Let’s analyze them. Around your neck, you have excess hanging skin and evidence of platysmal bands.
The only way to remove this excess neck skin and tighten the platysmal bands is by undergoing a revision neck lift. It is not too risky to undergo a revision even if you’ve had a deep plane facelift. Just because you had a deep plane facelift doesn’t mean you cannot have face lift or neck lift revisions. I would suggest the prior incision be used, and tissue dissection be carried out above the SMAS. The SMAS should be tightened as well as the platysma. The neck skin should be re-draped and tightened.
In conclusion, I would definitely suggest a surgical revision through a facelift approach to the neck. Forma and Coolpeel will do nothing for your neck fat and muscle bands. Good luck. I hope that I have answered your question regarding what should be done and how your neck can be fixed six months after a deep plane neck and facelift.

Ali Cetinkaya, MD · Answer

Thank you for sharing your detailed experience. Hollowing and sagging after a deep plane facelift &mdash; especially in patients with significant weight loss &mdash; are not uncommon.
What Could Be Causing the Hollowing and Sagging?These changes may result from:
Excessive release or loss of fat compartments
Gradual relaxation of deep tissue layers after surgery
Volume depletion or collagen loss in the midface and jawline
Are Forma and CoolPeel Effective?These are non-surgical options:
Forma uses radiofrequency to stimulate skin tightening.
CoolPeel is a CO2 laser treatment aimed at improving skin texture.
While they might help with mild laxity or skin texture, they are unlikely to address structural hollowing or deeper sagging caused by volume loss or tissue descent.
Is Revision Surgery Too Risky After Deep Plane?Revision after a deep plane facelift can be more complex, because:
The dissection goes deeper and closer to facial nerves.
Scar tissue might have formed.
However, that does not mean revision is impossible. In experienced hands, it can be safely done &mdash; especially if the issue is localized.
Suggested Alternatives:Strategic fat grafting (lipofilling): Can restore volume safely.
Temporary fillers: As a test to assess the potential improvement.
Revision surgery: After a proper evaluation by a board-certified facial plastic surgeon.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

In general, deep plane procedures for the face and neck can be revised but sometimes they just need  adjustments.

There seems to be still some laxity under the chin and often the best vector to reduce it in valves scars in from of the temple hairline. There seems to be also some volume under the chin that could be addressed together with tightening and repeat platysma plasty.

You can get a sense of the volume issues that are outstanding if you lie down completely flat and have a look in the mirror. It seems that the central part of the neck may look fine but there may be some volume excess lateral to it also when you lie down. This can usually be corrected to a reasonable degree.

In situations like yours, a consultation in person is significantly more valuable than photo evaluations to understand better the tissue characteristics.

Brian K. Machida, MD, FACS · Answer

If you had surgery, a revision tightening with Forma and Cool Peel will not work.  The lateral bulges either represent dehiscence of a platysmaplasty suture with relaxation in the midline or a deep plane technique done without any platysmaplasty.  Although some platysmaplasties impair the lateral superior pull from a deep plane technique, it is sometimes necessary to make the midline neck even.  A revision of a deep plane at 6 months is not too risky for a surgeon familiar with the technique who can adjust surgery depending on what was done.  I would advise a revision deep plane with a platysmaplasty dissection above and below the muscle to get adequate pull in the midline.  If you get a revision, be aware that the surgeon cannot just do more of the same...It has to be a different technique.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs and I am sorry that your surgical results have not been what you anticipated. Unfortunately the only improvement based on the severity of your results is through a revision neck lift to tighten the neck muscles, possible fat transfer and remove the continued excess skin.

Jacob Tower, MD · Answer

Hello, hope you are well. I am one of the doctors that responded to your initial post--thank you for following up with additional photos. There is a confluence of problems in the central submental neck that amount to a cobra neck deformity. My recommendation would be to wait 6 months and then seek revision surgery. The persistent jowling of the lower face can be addressed at the same time. Surgery is never without risk, but it can be done safely. 
Best,Dr. Tower

Darryl J. Blinski, MD · Answer

Sorry fir the very poor result. Best to seek only in person opinions. I would after seeing you most likely recommend full revision of neck with plication. Fee $10,000+. Best to arrange in person consults only .

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