After 3 lifts with revisions, is it safe to have another lift to the lower neck and jowls? (Photo)
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Doctor Answers 10
Another neck lift revision is safe, but I don't see jowls. You can correct the jawline by adding volume and improving the skin
A little background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have practiced in Manhattan and Long Island for over 20 years. Face and neck lifts are a very significant part of my practice, as well as non-surgical options for facial aging changes.
The first question I would ask someone like you is what exactly are you looking to improve? With the photo you submitted, and I see the area you refer to as jowls from the front, but it doesn’t appear to me you have significant jowling. What I would offer is a perspective at this stage of my career where I’m very happy to report there are options better than what was available 15-20 years ago.
Let’s start with the definition of a jowl. A jowl is usually a result of loose skin and some fat below the jawline, which indicates performing a facelift, or a face and neck lift. When someone complains about jowling, very often they don’t appreciate the loss of bone in an area called the mandibular notch that makes the area next to it look elevated or more prominent, which people think is jowling. Often people feel their skin needs to be tightened, and the surgeon would try to tighten the skin, but the patient would still feel they have a jowl.
To address an area of deficit in the bone structure, and understand that facial aging is a combination of descent or sagging and volume loss, there’s a strategy that we employ called structural volumizing. We use fillers placed in the level between the bone and muscle to fill out this area and improves the bone loss below the muscle. I can also offer patients a permanent solution such as a pre-jowl implant or if someone has a weak chin, we can put a chin implant because the tail of the chin implant actually fills in that area. That’s one part of the equation without needing another surgery.
The other part of this equation has to do with skin quality. Many people will complain after surgery that their skin is still loose and that the doctor didn’t tighten the skin enough. I can assure you that myself and my colleagues who perform facelift and necklift do our best to make the skin as tight as is appropriate, without over tightening or creating those undesirable tension lines. People feel this way because of skin quality. The actual makeup of the skin, the loss of collagen actually makes the skin stretchier. When it comes to skin quality, you’re not going to benefit from just more pulling and lifting. A plastic surgeon colleague of ours said years ago that the skin is like taffy - the more you pull on it, the more it can stretch.
In our practice, we actually have a non-surgical approach to skin quality improvement on the face using a non-ablative laser. The laser heats the deeper tissues of the face as well as the skin to help remodel the skin and to improve its quality. A non-surgical approach again is offered there. I often combine this with platelet-rich plasma which is derived from your own blood to stimulate your body’s collagen and blood supply.
The challenge with compounded aging changes and sun exposure is the skin gets very thin. It becomes a balance of how much to lift, how much to rehabilitate by improving skin quality and volume in a strategic way. Often, when we talk about structural volumizing, the point of doing it at that level is the skin is no longer a critical factor. When fillers are typically used by most doctors, it’s placed within the skin either at the dermis level (the backbone of the skin), or under the skin. Unfortunately, the skin can only tolerate so much weight, so you can’t get as much of a correction as putting it at the bone level.
The photo you submitted showing the lower neck, shows you might be dealing with a skin quality issue over a skin quantity issue. There are terms for the aging changes of the neck such as Poikiloderma of Civatte or other changes of fine lines, wrinkling, discolorations, telangiectasias or little blood vessels, or just generalized skin quality diminishing with aging. People often want their skin lifted to make things look tight and good because when they stretch the skin, it looks good. Unfortunately, there’s a limitation to skin tightening because you have to turn your head and move around. So it is something more amenable to PRP and laser treatment.
As far as answering the question of safety to do another lift, I would say that it is typically safe unless there’s any issue with the blood supply, vascularity and the quality of the skin, but I think you have other options to address the issues that concern you. Meet with doctors, and maybe meet with the original doctor who performed these procedures you. Learn about these other options: fillers to add volume, laser or thermal energy devices to improve skin quality and skin tightening, but done intelligently and strategically because too much of everything is never a good thing, but doing it in the right amount and the right way can really make an impact.
I hope that was helpful, I wish you the best of luck, and thank you for your question!
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It is definitely safe to have another procedure as long as you have found a physician you trust. You could also seek alternative solutions such as ultherapy, laser skin tightening or filler augmentation to improve the jawline.
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You should consult an experienced board plastic surgeon with good reputation in facial reanimation for detailed evaluation and discuss your options. Good luck.
Best of Luck
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From the limited views that you have provided and without touching your face it is difficult to judge precisely what would serve you the best. It seems to me that a limited neck lift along with fat injection to your face specially around the mouth may provide the necessary improvement. Please consult a plastic surgeon who has experience repeated facial surgery through Skype, FaceTime or in person.
Revision face and neck lift candidate
Surgery not indicated based on photos
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