8 Months Post Neck Lift: Doctor Recommends Z Plasty

This is a case where photos would be very helpful. There are several scenarios for bunching or puckering after a neck-lift: 1) inadequate skin removal at the time of the primary procedure, 2) suboptimal skin re-draping after the primary procedure, 3) contour irregularities with the platysma and/or submental fat, 4) inadequate release of the mandibulo-cutaneous ligaments during the primary procedure.  A submental Z-plasty will only address the first cause, but will not be helpful for any of the other listed reasons.

Without photos, it is impossible to assess your problem and the effective way to handle it.  Z-plasty is not typically associated with scar revision or puckering in the neck region.

It is impossible to advise without a photograph. Z-plasty is rarely done in teh neck and only in a patient with loose and excessive skin. Even then, teh skin can be pulled laterally and removed.

 Sadly, without photos of your neck there's not much to go on.  If a skin revision didn't sort out the problem previously, I suspect the bunching is related to the fatty or muscle tissue layers which would require revision surgery at that level...Z plasty is another form of skin resection and by itself does not address these deeper layers.

What you are describing are very unusual problems after a facelift.  Photos are critical here as is going to at least three expert plastic surgeons for another opinion.