I'm 7 years post facelift. The physician left a tire around my neck and then lipoed it. What can be done? (Photo)

Price for revision. Can you make my neck look smooth again ? Many thanks for any information.

Doctor Answers 20

Possible causes of swelling and extra skin at your neck, and treatment. Your revising surgeon will need details

Thank you for your question. You’ve submitted 3 photos of your neck area, and state it has been 7 years since your facelift which left a “tire” around your neck which your surgeon lipoed. You’re asking about some type of procedure to make your neck look better.

I can certainly give you my approach to assess a patient like yourself in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years and face and neck lifting surgery from suture suspension, minimally invasive surgery, to short scar to advanced deep plane face lifting is a significant part of my practice. Without seeing your pre-op photos and getting more details about your post-operative progress after your surgery, I’m just going to give you a little insight of how I make a decision or recommendation for the best option.

SIo to begin with, it is likely you chose a doctor you felt was competent and capable to do your surgery. The appearance you have is a combination of some excess skin, and what looks like some degree of scarring which we call adherent skin. What you describe as a “tire” may be swelling or a lot of fluid after surgery, which is referred to as seroma. A possible seroma requires active management such as tapping and removing fluid, so it is important to identify and describe very specifically your post-op experience from the previous surgery before you undergo your next surgery.

When doctors do face and neck lifting surgery, anyone who performs this operation has their own unique style of doing the procedure, but we all want to be comfortable and happy with the result on the operating table. The golden rule is if it doesn’t look good on the table, it doesn’t look good outside. On the operating room table, it is likely you didn’t look good and everything was not satisfactory. If that’s not the case, or if you did not look good soon after the surgery, that’s a different story, and may involve post-operative care. There may have been complicating issues, with the most common ones being hematoma, bleeding, and seroma which is a mixture of inflammatory fluid,leaky vessels, and lymphatics that occur from surgery.

It is no question you will likely benefit from revision neck lifting surgery. There are other technologies we employ these days in my practice where we do things to help the skin quality before undergoing surgery because you don’t want a repeat performance if your body has a tendency to form these types of seromas. I would ask questions about your original surgery like if laser performed, or if this was a laser-assisted procedure, about the circumstances, medical issues you had at the time, and what other active medical you may have now.

Technically, there are a lot of ways to approach your aesthetic appearance, but I think you have to provide really good, detailed information about your experience post-operatively to avoid a repeat. Experience. This may be a systemic issue, or a local tissue response issue that is beyond just the technical aspect of your surgical procedure. I think one of the unfortunate realities right now is that there is so much inter-specialty rivalry, and people claiming they are better surgeons than everybody else. Having technical expertise and experience are very important, but also understanding the canvas of the person who you are treating, and managing all the variables are critically important before you move forward.

Meet with some cosmetic surgeons and learn about what the least invasive to the most aggressive options are. See what you’re comfortable with, and understand the risks. Understand what may be necessary in case you have a repeat performance such as a seroma formation that wasn’t managed as well, or maybe how your doctor would approach that issue.  Basically ask more about the complications and also try to recall all the details of your previous experience. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 66 reviews

Revision facelift

Based solely on your photo, I think that your only course of action would be a revision neck lift to correct the skin laxity. My best advise would be for you to schedule a consultation with a board certified plastic surgeon in your area who can assess you in person and discuss your options.  

Kindly,

Kouros Azar

Kouros Azar, MD
Thousand Oaks Plastic Surgeon
4.9 out of 5 stars 31 reviews

Neck "tire"

Dear RI:

Thank you for presenting your neck issue to the panel. Your picture shows a combination of skin redundancy and scarring. Only a full secondary face/neck lift, done carefully, can have the chance of gaining the correction you seek, and it will not be easy (because of the scarring, "folding" and adherence of the skin across the centraL neck). The contour irregularities may not be totally correctable, but some improvement should be possible (but optimal results may well require ancillary techniques, like some judicious fat transfer to the thin, scarred and adherent areas). I recommend you see an experienced board-certified plastic surgeon in your area for examination and planning for your procedure. Best wishes!

James H. Scheu, MD, FACS
Saint Louis Plastic Surgeon
4.6 out of 5 stars 23 reviews

Secondary Facelift

Hello.  Thank you for your question.  I suspect that your results were likely better several years ago, but since I don't have photos from the early postop period, it is impossible to make any assessment of the result of your previous procedure.  It is normal to get progressive skin laxity as you age following a facelift.  It appears from your photos that you have a lot of skin laxity and laxity of the underlying muscle in the neck.  You also appear to have some tethering of the neck skin to the underlying muscle.  You would need to have a secondary facelift procedure to fully address these issues and get the best result.  I would not necessarily consider this a revision procedure, because it has been so long since the initial procedure.  I would consider this a secondary facelift procedure, which is not uncommon several years after a primary facelift, in order to maintain a youthful neck and jawline.  Also, you need a full face and neck lift, not some type of mini-lift procedure.  The price for a face and neck lift varies from one surgeon to another, depending on their experience and expertise, and from one region of the country to another.  I would not make price your primary consideration.  Sometimes "you get what you pay for".  I would encourage you to seek a consultation with a board-certified Plastic Surgeon or Facial Plastic Surgeon with extensive experience in facelift and facial rejuvenation procedures, in order to allow them to assess your individual anatomy, concerns, and goals, and determine the best treatment plan for you.  I wish you the best in achieving your aesthetic goals.

Michael Boggess, MD
Nashville Facial Plastic Surgeon
4.9 out of 5 stars 38 reviews

How to improve neck contour.

Thank you for your photos.  Your photos show a large amount of skin laxity and redundant skin and muscle.  The only way to achieve the best contour for your neck is  revision facelift, where the tissues can be contoured appropriately and re-draped in a smoother fashion.  The old scarring from the liposuction must be released to allow the tissues to re-drape.  See a board certified plastic surgeon for a detailed consultation.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 91 reviews

Neck problem

It can be very difficult to correct your problem if there is a lot of scar tissue under and involving the skin of your neck.  If the area was very hard for a long time after the surgery there is a fair chance of having that problem again.  Apparently you are concerned about this possibility as you have waited 7 years before asking this question.  You should see a senior surgeon who has had a lot of experience with this problem.

Barry N. Silberg, MD, FACS
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 4 reviews

Redo the facelift

From your photographs, it appears to me that you have a fair amount of laxity of not only the skin but also the underlying muscle. There is no small touchup that will address these issues. You would be best served to have a redo face and neck lift. Best of luck with that surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 48 reviews

Revision face lift - what can be done?

Thank you for asking about your face lift.
  • I am sorry you were disappointed with your face lift result.
  • Your photos show loose skin and loose neck muscles.
  • You will need what is called a secondary face lift - it will need to be re-done with correction of the loose skin and muscle.
  • The cost is likely to be the cost of a face lift - these costs cary from one region to another.
  • Please see a Board certified Plastic Surgeon near you - consider several opinions - to find the right surgeon.
  • To start looking, go to the website of the American Society of Plastic Surgeons and search for those near your zip code.
Always see a Board Certified Plastic Surgeon. Best wishes  - Elizabeth Morgan MD PHD FACS

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 reviews

Revision facelift

The only way to make your neck look great again is with a revision facelift. The muscles under the chin need to be addressed, and the soft tissue needs to be contoured. The lift from the side will treat the jowl and get rid of the excess skin. I recommend seeing someone who specializes in facial rejuvenation and has extensive experience with revision facelift surgeryAndrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Necklift revision

Your photos suggest a significant amount of skin laxity under the chin, with evidence of platysmal banding (muscle separation) as well.  Most likely, these findings would benefit from tightening the separated neck muscles both in the middle and at the sides of the neck.  The lax/ bunched-up skin under the chin needs to be redraped and smoothed over the tightened neck muscled, with its excess removed behind the ears.  Depending on the findings in your cheek, you may require a bit of a cheek lift as well.  Hard, lumpy scar tissue, if present, is generally best softened prior to surgery.  Consult with a facial plastic surgeon or general plastic surgeon well-versed in facial rejuvenation.  Good luck!

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

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