Could I have separated the platysmal muscle 5 months after facelift surgery? Do I need revision or a whole new facelift? (Photo)

Thank you for sharing your photo and asking your question. Based on your personal history of the events and the image you provide I feel that you would require a revision neck lift procedure. There is excess skin, the appearance of platysma separation, and maybe submandibular gland fullness. The burning along the left side of the neck does not represent the mid-line treatment of the platysma, but most likely represents the release of a scar or part of the outer attachment of the platysma. If you did not develop bruising in the region after pain and burning, then you do not/did not have a hematoma (blood collection). The lion's share of swelling is resolved by 6 months so I would not point to this as the culprit of your concerns either. I am sorry that you have these concerns and I am certain that your surgeon would want to address them. I advise that you contact your primary surgeon to express your concerns. If they are not addressed, then I would recommend obtaining a second opinion. I hope this helps you in finding your answer.Be healthy and be well,James M. Ridgway, MD, FACS

A neck lift operation addressing residual neck banding may be necessary. The persistent neck band is likely to be the platysma muscle. In this case, a neck lift would be beneficial. However, I would also recommend redraping of the neck skin and lower face through the lower facelift incision. I would consult with your plastic surgeon regarding these options. 

Based on your photo, and on your history, it is unlikely that a suture came undone or your muscle was pulled apart 5 months later.  It seems you may need to have the muscle reapproximated.  Sometimes removing too much fat centrally can create a similar deformity and sometimes the submandibular glands can contribute to that appearance.  Partner with your plastic surgeon to see what can be done.

The symptoms you described don't add up to a specific diagnosis but the photograph looks as though some revision of the platysma muscle might be of benefit. One would also want to examine the sub mandibular glands carefully to see if they are large.

the best thing would be to be seen in person by your surgeon who can examine you to determine what is going on.  If this happened 5 months after, you may have a fluid or blood collection that developed.  It is unlikely that a muscle tear would create this appearance.

Based on the photo you provided you'd need to check with your surgeon to make sure you don't have a collection of blood/fluid creating that lump on your left side. It's possible that a suture pulled on the muscle in the area as you were looking up while painting, but that alone wouldn't explain the large swollen area. We're a bit limited in evaluating the area without seeing it in person, though.

At 5 months you should not have residual swelling that requires more time to resolve.  I would consider a revision.  It may be necessary to redo the platysmaplasty and either fat excision or grafting.  Discuss this with your surgeon.  Best wishes!

Thank you for your question. It does appear that you have prolonged swelling postop. This can happen in some patients after a face and neck lift.  It does not appear that your muscle has loosened. Compression at night may aid in recovery. Discuss your concerns with your surgeon. Best wishes.

Given the time frame and that it happened while looking up with a sharp burning pain, it is likely that you either tore a small scar band or a suture that was used to suspend the soft tissues.  You are far enough out that the suture should no longer be necessary for support, but in either case, there may be significant acute soft tissue swelling and sometimes bleeding.  You should see you surgeon to evaluate this.  I'm sorry to corroborate your thoughts, but the photo results don't look very good and you may end up needing a touch-up procedure once this acute inflammation has settled out.  Best of luck.

you do have some residual swelling on the left.  The platysma won't just open up.  It may loosen over time.  The area you have swelling is probably the most common spot for people to have some persistent swelling in the fat, and is also over the gland.  If it hasn't gone away after about 6 months, your surgeon may elect to do a small tightening under the chin.