I had chin lipo a year ago and now I have an indentation under my chin. Is this cobra neck? What can I do to fix this? (Photo)

Question

Over aggressive chin lipo has left me with an indentation under my chin.

Gianfranco Frojo, MD · Answer

This is not an uncommon outcome after overaggressive liposuction of the neck. The indentation you are seeing is the borders along the platysma muscle of the neck. I would recommend an open neck lift to bring the edges of the muscle back together in the midline and tighten those deeper structures.  I recommend seeing a plastic surgeon who has completed at least 6 years of plastic surgery training (ideally 7 if an aesthetic fellowship was completed).

Justin Yovino, MD, FACS · Answer

From the photo it appears that you are dealing with skin and scar tissue. Likely, all of the fat has been removed and now you are experiencing the result of deflated skin on top of scar tissue between the skin and underlying platysma muscle. The are options to approach this issue. Non-surgical procedures were including the microneedling / radiofrequency combination such as Morpheus8. A series of 3 or more sessions may lead to enough skin tightening that it becomes a more satisfying appearance. A more definitive approach would be surgical. A neck lift would allow for redraping and lifting of that skin. A neck lift would require an incision underneath the chin and behind the ear. I would not address this situation with more liposuction.

Jacob Tower, MD · Answer

Hello, hope you are well. The photo that you submitted shows a platysma band tenting the skin away from the neck. This would not necessarily be related to your history of chin liposuction. If you submit additional photos of your neck from different views, it may give a better sense of your concern (especially from the front with the head in a neutral position, and tilted back). Nevertheless, for the platysma band, you can trial botulinum toxin as an initial step to help diminish the appearance. For persistent cording, there are surgical options (short scar neck lift with platysmaplasty, etc).
Best,Dr. Tower

Dallas Buchanan, MD · Answer

Thank you for your questions. I would not describe this as a cobra neck deformity, but rather the removal of the fat tissue has exposed underlying deeper anatomy. The cords you are seeing are called platysma bands and they are formed by an underlying muscle in the neck. The most definitive treatment option would be a surgical necklift, but if you are not ready for that, there are some minimally invasive treatment options (MyEllevate) as well as some non-surgical (albeit temporary) options as well such as Botox. 
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Jason Emer, MD · Answer

We do this frequently in our office and call it a cobra lift, we do skin removal, muscle tightening (platysmaplasty), VASER and J Plasma all to contour the chin/neck in one treatment.  Best, Dr.  Emer.

Stephen Prendiville, MD · Answer

Cervical liposuction serves to remove superficial or supraplatysmal fat.  What this does is help uncover the deeper anatomy and you are now seeing platysmal bands, which are a natural consequence of aging in the neck. The only solution for this is a neck lift and/or a facelift.  A consultation is necessary to determine the best way to proceed.

David Tuggle, DDS · Answer

There are a couple of ways to treat this non surgically. Purchase a jade roller , heating pad each night and aggressive massage, many times this will soften the area. Another option is some botox to the bands so see if they respond. Surgically a platysmaplasty could be considered but I would try the other non surgical treatments first.

Darryl J. Blinski, MD · Answer

Sorry for the slight hanging sub chin effect from liposuction as seen in your 1 posted photo.  I would offer mini neck lift with SMAS plication under IV sedation & local anesthesia to correct this. Fee from $5,000. Best to virtual consult with....

Adam Goodwin, MBBS, FRCS(Plast) · Answer

chin lipo is a good minimally invasive technique but it will uncover underlying problems like stringing or banding platysma and will leave scarring behind. these are simply the limitations of the technique. 
you have a well defined jawline so a neck lift is probably too powerful at the moment. unfortunately everyone thinks that plastic surgery outcomes are invisible and they very rarely are. try and accept the improvement rather than lament the disadvantages.

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality, liposuction results is more difficult than most people realize. The number of plastic surgeons who truly mastered this procedure are in a small minority. Unfortunately, Liposuction results have substantial variation, depending on who you choose as your provider. For this reason, I suggest patients be very careful before scheduling surgery. I generally recommend patients have multiple in person consultations before choosing a provider. During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures of previous patients with similar characteristics.
An experienced plastic surgeon should have no difficulty showing you before and after pictures of at least 50 previous patients.
I recognize that this point provider selection is a little late, but considering that revision work is many times more difficult than primary Liposuction importance of finding the right provider is if even greater importance. 
Generally, speaking, liposuction should be considered a permanent and irreversible procedure. Correcting poorly done Liposuction is generally done with either revision Liposuction, fat transfer or a combination of both.
Sometimes improvements can be made by converting the procedure to a skin tightening operation like a tummy tuck for the abdomen or a neck lift for the face.
Your situation is not going to be easy to improve upon. Fat grafting may be a possibility, but grafting fat to correct overzealous Liposuction is inherently difficult.
In the hands of the right procedure, it may be possible to gradually graft fat to restore the subcutaneous fat layer that should be there. Afton incremental stages of improvement best to patients can hope for, and sometimes restoring the outcome to a more favorable. One may take more than one procedure. Simply doing revision Liposuction, with removing more fat can easily make things worse.
Be apprehensive about providers who think this is an easy problem to fix, or that some technology or device can easily fix the problem.
The process of finding providers for a vision work is more or less the same as it is for finding the right provider for Primary procedures. The biggest difference is going to be bedding providers for both Liposuction and fat transfer skills.
I suggest taking a systematic, careful, slow approach, interviewing as many providers as possible before making any commitment to secondary procedures. Recognize the inherent difficulty in the situation and recognize there is some in here to risk, including the situation, becoming worse, if you’re not in the hands of the right provider.
Liposuction is a deceptive procedure for both patients and providers. Inherently it seems simplistic and unfortunately people sometimes view the procedure has been just that. In reality doing this procedure well on a consistent basis including the ability to make accurate predictions regarding candidacy, and delivering consistent outcomes, is a whole other story. Like I mentioned, earlier, the number of plastic surgeons, who have truly mastered this procedure are in a small minority.
Most plastic surgeons think they’re better at Liposuction than they actually are.
With results that are very different than what patients anticipated can be devastating and leave people with a high degree of anxiety, especially regarding more procedures. Understanding your candidacy for any procedure, and finding the right provider are always the key two ingredients to consistent high patient satisfaction.
Best,
Mats Hagstrom, MD

I had chin lipo a year ago and now I have an indentation under my chin. Is this cobra neck? What can I do to fix this? (Photo)

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