Is this Cobra neck? What can be done to fix this? (Photo)

Question

My surgery was 10 mos ago and I hate the results. There is an obvious indentation in the center of my neck (under my chin) and two bulges on both sides. What caused this and what can be done to correct it? Please help

Robert M. Lowen, MD · Answer

Dear Original,
  When you open the neck and defat, the skin can stick down and look irregular like yours does in the middle. The bulges on side of the midline may be fat or scar tissue or a combination of both.  The problem is that operating again causes a healing reaction that tends to recreate the original problem.
  Some one should evaluate you in person and see if you need a combination of central fat grafting and bulge reduction liposuction.  It would be nice not to open the neck again, if possible.
Sometimes depressions and scar can be improved with nanofat grafting as well.  At some point you may need to have the central platysma bands cut.  The non-incision MyEllevate procedure can cut the bands with the suture, that is then used to pull the muscle and overlying skin up and in to the cervicomental angle.  This is a relatively new and novel necklift but may be of value when combined with a very patient approach to improving the skin quality that is tethered by scar, judicious liposuction of the bumps and some type of fat grafting  to the thin or depressed areas.

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.
The contours under the chin suggest volume excess from the digastric muscles and lower part of the submandibular glands.
You you A deep plane neck lift can address the remaining volume by reducing the digastric muscle bulk and plicating them in the midline as well as reducing the lower part of the submandibular glands.
Additional skin tightening may be possible but may also not be needed.

Jason Emer, MD · Answer

We do this frequently in our office and call it a cobra lift, we do skin removal, muscle tightening (platysmaplasty), VASER and J Plasma all to contour the chin/neck in one treatment.  Best, Dr.  Emer.

Stan M. Valnicek, MD · Answer

Thank you for your question. At 10 months the swelling from surgery should be gone and the contour is likely fairly stable. The goal of neck liposuction or direct fat excision is a smooth contour extending to the angle of the jaw and sternocleidomastoid muscle on either side. With contouring, you can get some unevenness as things heal for a variety of reasons. 
I cannot speak specifically to your situation without an in person exam but some speculation can be made based on the photos and my personal experience treating neck fullness. It is also unclear from your submission what specific procedure you had that led to this result (direct excision, liposuction, fat dissolving injections or energy application with RF/laser, etc.). My comments are intended in a general sense and not as specific advice in your case. 
Central depression can be due to excess fat removal in that zone or inadequate fat removal on either side. Often it is the combination of both. Excess fat removal can lead to tethering of the skin to the underlying muscle or central hollowing. Restoring volume with fat grafting can help although it often needs more that one session. Inadequate fat removal on either side can be dealt with by suctioning a bit more fat laterally and I did that for one of my own patients last year. 
Some patients might also have contour problems due to thick digastric muscles or hanging submandibular glands. Neck anatomy is complex and optimal definition can require addressing the structures deep to the platysma muscle. Not all surgeons are comfortable with this zone as the risk of complications is higher.
For specific recommendations in your case, I would go back to the original surgeon and discuss the contour and how it might be improved. A second opinion with a respected board certified Plastic Surgeon in your area could be useful. You really need a proper exam and evaluation in person to diagnose the underlying issues and develop a safe and solid plan for smoothing area that out.

Scott C. Lindsay, DO · Answer

Thanks for your question! I would suggest reaching out to your plastic surgeon to discuss a possible revision to improve the contour. You could also get a second opinion to see what could be done. Good luck!

William Portuese, MD · Answer

Much more information is needed, such as what procedure you had done in the past, your age, height and weight. There appears to be residual fat deposits or prominent digastric muscles present. And neck lift procedure with a platysma plasty is going to be required to correct these issues

Matthew Hansen, MBBS, FRACS (retired) · Answer

You have had excessive and unbalanced removal of central submandibular fat especially posteriorly without satisfactory tapering of this laterally combined with inadequate redraping of the skin and platysma laterally. Was your operation just done from the incision beneath the chin? A combined periauricular and submental approach would be required to fix this.

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