Lower Facelift and Platysmaplasty 8 Weeks Ago and I Still Have Lump Under my Chin

Question

Is this normal or do I need liposuction? Prior to surgery my PS didn't think it was necessary and I didn't either(I am slender w/ good skin elasticity). When I saw him last we discussed the neck bands still present and the lump. He said that he should have done liposuction. I am not so sure although the neck bands are still there. I just think this may be a seperate issue and I don't want to have any extra unnecessary surgery. I am reading that these lumps are not so uncommon. Thank you

Richard H. Tholen, MD, FACS · Answer

If you and your surgeon didn't feel a need before surgery to address this area, the swelling and fullness you see now under your chin should improve over time, though this will take several months to completely settle. I'm sure both you and your surgeon will agree that nothing was "added" to this area other than post-operative swelling and perhaps some fluid or blood. The latter can cause increased scar fibrosis and result in subcutaneous firmness and persistent bulging in this area, but can also be reduced with massage therapy, infrared treatments, and ultrasound (we offer these treatments as part of our post-operative care regimen in our office surgical center), and possibly steroid injections. If a collection of fluid or blood is identified early, this should be addressed via aspiration or re-operation, but this is not possible now--the fluid part is long gone and all that remains is swelling and/or scar tissue.

	What is clear is that only time and resolution of the swelling component first, and then determining the scar fullness component, is needed before considering any kind of surgical revision. That way a proper and effective plan can be created. Rapid re-operation is something that patients (naturally, but incorrectly) want, and frankly, inexperienced and perhaps defensive surgeons fall prey to--premature re-operation is rarely good, and less likely to work out as everyone hopes. In fact, it often makes things worse (how do you think I know that?)

	So, my best advice is to be patient for now, remain on good terms with your surgeon (not blaming or angry but understanding that he did his best and wants his best possible outcome for you as much as you do), and figure out a joint plan. I always do my utmost to make less-than-thrilled patients happy when they are thankful for what I have done, appreciative that I did not willingly wish their concern upon them, and are willing to do their part in covering OR and anesthesia costs as we discuss before their first operation.

	Realize that the under-chin area is the most dependent area of the face and neck after surgery in these areas, and swelling, blood, and fluid, naturally tend to "go south" towards this region. Sleeping with your head elevated for the first three weeks after surgery and wearing an elastic shin strap for two weeks helps the tissues to adhere and heal evenly.

	Neck bands are visible platysma muscle fibers that are visible before and sometime after facelift surgery. The exact procedure determines whether these are reduced, eliminated (rarely), or left alone, but complete elimination of these bands requires cutting the muscle--some surgeons do this fairly routinely; others decry this as causing a (different kind of) deformity. Partial division can provide some improvement, but would involve re-operation. Botox can offer non-operative relief of these bands, but need to be repeated every 4-6 months. Liposuction does nothing for muscle bands, but re-operation to address the residual fullness and the bands should be tailored to your requests and level of concern, but not before 6-12 months has passed. Best wishes!

Matthew Richardson, MD · Answer

Some lumpiness, swelling, and irregularity is not uncommon during the first few months after any type of face or neck lift procedure. In some cases, massage or steroid injection might be indicated, but most patients simply require time and patience. While I cannot comment on any particular surgeon's technique or any individual patient's procedure, there are times where minor touch-ups can be performed to tweak the initial surgical result. In most instances, this is not something I would perform until at LEAST 4 to 6 months post-op, and often not until one year post-op.
Be sure to discuss any post-surgical concerns with your surgeon.
All the best,

Mike Majmundar, MD · Answer

Getting lumps after a facelift in general is very common.  If you had a platysmaplasty, the bands should be much improved at 8 weeks unless you have very active platysma muscles and it pulled through the stitches (it does happen).  Lumps under the chin are common for 8-12 weeks.  The lack of liposuction usually doesn't create lumps.

Stephen Prendiville, MD · Answer

Although it is totally normal to have some degree of swelling 8 weeks after a Facelift, the residual presence of neck bands is not.  These findings can only be evaluated by your Surgeon and should be examined.

Kevin Sadati, DO · Answer

Dear Lower Facelift Patient from New Jersey,
	According to your description, you might have bunching of platysma band and skin, fluid collection, or generalized edema (swelling). Eight weeks post lower face lift is too soon to judge the long term outcomes. Talk to your Surgeon, or you can get a second opinion in two months if the issue persists. Good luck and good healing

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