What needs to be done on my lower face after a botched submental lipo procedure 3 years ago? (Photo)

Question

I had submental liposuction done on my lower face in 2021. The doctor took out way too much fat which left a large lump showing through on my left lower side. After having numerous other procedures (buccal fat removal, FaceTite, Morpheus, lasers) to try to fix my face, it still looks awful. What is the best suggestion to make this look better (not so lumpy and "loose")?

Stephen Prendiville, MD · Answer

I'm sorry that you have had a difficult time obtaining the results that you wish to have to meet your level of satisfaction. Liposuction in the neck is a fairly simple procedure and most likely uncovered something else: enlarged and/or drooping submandibular glands.  The solution for this problem is most likely a limited incision deep neck lift, but a consultation is necessary before making a definitive statement. Energy devices like morpheus will be absolutely zero help, so save your money on such "minimally invasive" devices.

Anna Chacon, MD, FAAD · Answer

Given the complexity of your situation following submental liposuction, a comprehensive approach may be needed to address both the lumpiness and skin laxity. Here are some potential options to consider:

Fat Grafting: This procedure involves transferring fat from another area of your body to the affected area to smooth out irregularities and restore volume. It can help improve contour and symmetry.

Dermal Fillers: Injectable fillers can be used to add volume and smooth out uneven areas. Hyaluronic acid-based fillers are commonly used for this purpose and can be adjusted over time as needed.

Microneedling with Radiofrequency: Treatments like Morpheus8, which you've tried, can continue to improve skin texture and tightness. Multiple sessions may be required for optimal results.

Surgical Revision: In some cases, a surgical approach might be needed to correct contour irregularities. A plastic surgeon can assess if a revision surgery could help address the lumpiness.

Skin Tightening Treatments: Continued use of non-invasive skin tightening procedures, such as Ultherapy or laser treatments, can enhance skin firmness and may improve the overall appearance.

Consultation with a Specialist: Given the complexity of your case and previous treatments, consulting with a board-certified plastic surgeon or a dermatologist who specializes in corrective procedures could provide a tailored treatment plan.

Each option has its own benefits and risks, and a detailed evaluation by a specialist will help determine the most appropriate course of action to achieve the best possible outcome.

Lucian Ion, FRCS · Answer

Thank you for your inquiry and for sharing your photographs. It appears that the liposuction to the lower face and submental region has unveiled the presence of the submandibular gland, particularly on the left side. This is a common occurrence when the gland’s volume, previously camouflaged by superficial fatty tissue, becomes noticeable following liposuction.

The typical approach for addressing this involves a deep plane volume reduction in the submental region. This procedure targets the lower part of the submandibular glands, the digastric muscles, and the deeper-seated fatty tissue, aiming to align these structures with the jawline contour and reduce the girth of the upper third of the neck.

When there is residual looseness around the jawline, a skin-tightening procedure may be indicated to refine the contours. Additionally, in cases where the chin is under-projected (which I cannot assess definitively from your photographs), a chin implant could improve the jawline contour. This implant can be placed through the same submental access used for the neck lift procedure.

However, in your case, it is more likely that tightening the soft tissues of the lower face would provide a more balanced and harmonious improvement to the facial and neck features.

John Michael Thomassen, MD · Answer

A temporal cheek lift would correct the nasolabial folds and marionette lines and the down turn of your mouth seen in the photos.  It is done via a small incision in the temporal hairline.  The procedure can be done under local anesthesia in the office.

Manish H. Shah, MD, FACS · Answer

Hello,
Thank you for your question. Without seeing you in person, my suspicion is that you have ptosis of your submandibular salivary gland. The treatment for that would be a deep neck lift and submandibular gland reduction. 
As we age the gland tends to enlarge and drop. Removal of fat by liposuction can make the gland show more. 
You may also need a chin implant to help restore the horizontal length of your jawline and optimize your neck contour. 
I hope this helps.
Dr. Shah

William Portuese, MD · Answer

The photographs are very limited, so please post a full set of facial and neck, photographs from all angles to make a determination about how best to proceed. It's important to know how old you are as well. It's also important to understand that there are two compartments of fat in the neck, and they're located both above and below the platysma muscle. You may have residual fat deposits above the muscle, or you may have residual fat below the muscle. In that location that you're looking at the bulge, that could also be the submaxillary salivary gland. You're probably going to need an in person examination to figure out the issues moving forward. You'll probably need some type of neck lift procedure to address all of the issues discussed above in order to contour your neck properly.

Darryl J. Blinski, MD · Answer

Based on the few posted photos, very difficult to give an accurate answer, but would recommend virtual consultation first then possibly mini neck face lift with Endo laser treatment. Or just try two sessions of Endo laser. Again, best of virtual consult with expect fees to range from $5000-$15,000

Mats Hagstrom, MD (license on probation) · Answer

To make a quality assessment regarding the outcome of any plastic surgery outcome we need quality before and after pictures.If you don’t have before, and after pictures, then ask your surgeon to forward the pictures they took.Personally, I’m not a fan of facetite. Delivering consistent quality liposuction results is more difficult than most people realize.The number of plastic surgeons who deliver consistent quality outcomes is quite small.Facialist are primarily determined by Facial skeletal bone structure.Issues of the lower third of the face are therefore related to the shape and size of the mandibleCreating a bigger mandible isn’t really an option for most people so plastic surgeons rely on soft tissue solutions for problems which are Meryli related to bone structure.This is why treatments are going to give a partial improvement at and sometimes simply fail and potentially make things worse. to get consistent quality results we need to understand the underlying ideology or problem.Correcting or improving un poorly done, Liposuction is inherently difficult and may not be possible.Some improvement may be possible, but recognize that any attempts at revision surgery can also make things worse.This is especially true if too much fat was removed and a surgeon relies on more Liposuction an attempt to correct the problem.Complete facial pictures are needed to make an assessment.This needs to include a proper profile picture.When there is no one single best solution expect plastic surgeons to have different opinions.I’m not a fan of buccal send removal.As we age loss of facial volume becomes a major issue,Volume enhancement, using fillers in the pre-jowl sulcus maybe helpful in your case.Chin augmentation may be an issue, but we need to see profile pictures to assess your mentalis region.The outcome of your previous procedures is unfortunate.I recommend you always insist on providers, opening their portfolio and showing you their entire collection of before and after pictures of previous patients who had similar facial characteristics for any recommended procedure.Bring pictures of your face to use as reference during The consultation.Consult with multiple providers before considering any permanent irreversible contouring procedure.Best,Mats Hagstrom MD

What needs to be done on my lower face after a botched submental lipo procedure 3 years ago? (Photo)

Answers (8)

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