4 months post op from a lower face/ neck lift and I still have discoloration (left over from brushing). Any suggestions? (photo)

This may or may not be the case, but my first thought upon seeing this is a small hematoma or a small collection of old blood.  At this point, I would be massaging that area many times per day. This will help break up scar tissue and possibly the old blood.  Use a small ball or rolling device to help with the massage.  Consider a professional facial and neck massage with focused attention on the fullness.  

With the sizable amount of trauma from the facelift, steroid injections, laser treatment the skin is been fairly thoroughly assaulted. You need to allow it to heal. I guess is that it will return to a fairly normal color.

Healing after a faceliftThis is a more unusual time period but can be improved with laser and topical such as arnica cream if this is only pigmentation from bruising

If you still feel comfortable with your surgeon, I would trust his or her advise as most intimate with the ins and outs of your case. Laser can certainly help with the discoloration but will take time. However, if you are feeling uncomfortable with your surgeon, you might want to seek an second opinion from a board certified plastic surgeon in your area. Hope this helps and sorry that you going through this -- Dr. Nazarian

There are various causes of the findings that you describe and show in your photos.  Non-emergent causes that will take time to improve include swelling of the skin and underlying muscle depending on the type of procedure performed, hyperpigmentation from trauma, old blood clot that has broken down. These can be treated with massage, lasers, steroids, ointments and time. More worrisome causes include a blood collection or damage to the vessels of the skin which I am confident that your surgeon will diagnose if present.I recommend you continuing to follow the advice of your surgeon and maintain your follow-up visits through the  healing process.

It appears to be from a small collection of blood under the skin.  Sometimes by opening part of the incision and exploring this area to remove any consolidated blood collection, the issue is resolved.  This may be considered if the latest laser treatment does not correct it.  

The hyperpigmentation in the submental area is most likely from bruising of the time of surgery.  It continues to get better on its own without any intervention.  However it can be expedited with the use of the appropriate laser.IPL would work very well to reduce the discoloration.  An over-the-counter cream called Dermend also seems to help with frequent massage in the area.RegardsDr. J

Sorry you are going through this but I recommend to continue to follow your surgeon's advice, or get a second opinion from a board certified plastic surgeon in your area.

I recommend that you follow the post-operative directions your surgeon provides. Without more details on the type of laser used, it is hard to provide specific instructions. If your surgeon used an ablative laser, I would typically apply a moisturizing ointment to the area until the skin has healed. For persistent erythema a topical steroid is sometimes used, but specific treatments vary among practitioners. Try not to become discouraged. Good luck!

Sometimes small fluid collections remain whether ti was from blood or just seroma.  This can lead to a brawny edema and may lead to discoloration. The deems can take many months until it resolves. The color issue can take a long time as well and sometimes lasers can help.