Can "Bad Skin Elasticity" Cause Poor Cosmetic Surgery Results?

I had a face lift and neck lift 7 years ago that did not turn out well either. My neck is lumpy. I have extra skin below my left ear. I had to have revision surgery because the skin on my right ear lobe was pulled down. My surgeon's response was that I have bad skin elasticity. It wasn't his fault. Do some people really have bad skin?

Doctor Answers 8

Skin Quality and Post-op Results

There can be different issues with "skin quality" and the effect on post-op results.

The first is any tendecy towards scar problems. This would include patients that tend to heal with keloids or hypertrophic scars. Interestingly, patients that are older tend to have finer scars than people who are younger but this tendency can be overridden by people who have scarring problems.

The second has to do with skin elasticity. Depending on the the amount of collagen (and the type) in your tissue you have a certain elasticity. Patients with less elastic skin tend to be more challenging to achieve good results.

There are also a subset of patients with collagen or inflammatory disorders where cosmetic plastic surgery is actually contra-indicated.

I'm sorry you're disappointed with your results. Try getting a few opinions from board certified plastic surgeons in your area.

I hope this helps.

San Francisco Plastic Surgeon
4.8 out of 5 stars 49 reviews

Skin quality does affect the result a person receives

There are many issues with the skin that can make one patient's result from a facelift less optimal than they would like. Basically it comes down to elasticity in the skin. The better yours is, the better the result will be and the longer it will last. Factors that affect elasticity are your genetic background, history of weight swings, acne scarring, and sun damage. Seriously sun damaged skin will never allow for the same result from a facelift as non sun damaged skin.

That being said, it doesn't sound as though your problems were entirely from your skin but rather with technical problems with how your surgery was done.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

No such thing as "bad" skin

It is important to perform the procedure that fits the anatomy and the expectations, not the other way around. Too often a "standard" procedure is performed without customizing it ,or modifying it or the patient's expectations, to accompany the anatomical realities. Skin quality is variable for sure, but if a patient's skin is "bad", the procedure should take some of that into consideration. Skin might be "thick", or "thin", have lost elasticity, or is prone to hyperpigmentation or hypertrophic scars, but it does not usually cause lumpiness, pulled-down ear lobe, or residual sagging skin. You might ask your surgeon what he means exactly by "bad".

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 11 reviews

Is there such a thing as "bad skin"?

There is no question that some patients' skin heals better than others, and produces less noticeable scars. Almost everyone heals very well in the face. There is greater variation in how noticeable a scar from cosmetic surgery will be on the breast or in the abdomen. So, if by poor results, you mean thick scars, then it is possible that this is related to the quality of your own skin. Otherwise, I don't really know what bad skin means. I am not sure there is such a thing as bad skin, and this does sound a little bit like "blaming the patient".

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

There are multiple factors that contribute to the final...

There are multiple factors that contribute to the final result after facial rejuvenation surgery, and the quality of the patient's skin is indeed one of them. Other factors include age, smoking history, overall medical health, type of procedure chosen (there are multiple ways to rejuvenate the face, include many different types of facelifts) and the patient's inherent ability to heal. Given all of these factors, the communication between the patient and surgeon is critical so that the patient understands completely what the risks are and what to expect in terms of the result.

Shahram Salemy, MD, FACS
Seattle Plastic Surgeon
4.9 out of 5 stars 149 reviews

Skin quality can have an effect on results

Elasticity of the skin is an important predictor for outcomes. The thinner and less elastic the skin, the less it is able to contract and tighten in response to various laser procedures and the less it supports in response to surgical lifting procedures.

In general, younger skin has more elasticity (although this can be patient dependent), genetics, smoking, nutrition, sun damage are also factors in healthy skin quality.

In certain cases, poor skin quality or elasticity can be partially reversed through the use of laser resurfacing techniques. Resurfacing can eliminate damaged collagen and elastin, remove old sun damage and stimulate your body to make newer healthier collagens. So there is hope for SOME reversal and some patients should consider some of these procedures ( CO2 laser, fractional lasers) prior to having a major lifting procedure.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

Sometimes the painting is only as good as the canvas!

When you evaluate the results of facial rejuvenation, there are technical (the surgeon) and physiologic (the patient) issues that need to be optimal to get the best, longest lasting results. Surgeons who perform facelifting surgery frequently are more likely to get reproducible results. There are many ways to perform a facelift, but typically a surgeon will master and utilize a handful of these ways making is easier to produce the same results in patients.

Factors that have to do with the patient, may make it difficult to get a good, long lasting result. I typically speak to my patients about the following: age, sun exposure history, sun screen usage, smoking history, body weight, water intake history, airborn pollutants, facial asymmetry, exercise routines, and family genetics of aging. I think we are all born with the capacity to age well, but when you throw in the multitude of ways in which we abuse our skin it makes it difficult to provide great results to some patients.

I tell my patients that the face ages in four layers: the skin, the underlying muscles, the facial fat content, and facial bone position. Facelifting surgery really only tightens skin and muscle. It does nothing to alter the age characteristics of the skin itself, or revolumize the facial fat or bone. I think that when all four areas are rejuvenated, the overall effects are more natural and pleasing to the eye (yours and those of people around you.) This means that working on your skin first may make any future follow-up facelifts more successful in your eyes.

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 56 reviews

Without examining a patient, it is difficult to tell you...

Without examining a patient, it is difficult to tell you this. In general skin quality can affect the results. As one ages, the elasticity properties of the skin weaken. This certainly can affect the long term results. Other factors that can impact the quality of the tissues are smoking, and sun damage to name a few. Some patients have inherited skin disorders which also cause their skin to be very lax.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.