Laxity one year after neck lift - do I need a revision? (Photos)

Question

I had a neck lift almost a year ago, followed by a revision due to significant laxity afterward. Here’s what I look like today. I still feel there is too much laxity, even after having both the initial neck lift and the revision. Does it look like I might need another revision? I’m in my early 40s and experienced weight gain and loss over 10 years ago due to pregnancy. Otherwise, I’m very healthy, maintain a healthy diet, and exercise regularly. I’m also not taking GLP-1 medications. At this point, I’m honestly embarrassed to be in photos, which was the whole reason I decided to have the procedure in the first place. I’d really appreciate honest feedback and insight.

Muhsin Yilmaz, MD, FEBOPRAS · Answer

Persistent laxity can be related to several factors, including skin elasticity, the degree of underlying muscle laxity, tissue characteristics, and changes in weight. It is important to identify the underlying cause before considering any further intervention.
A revision may be appropriate in selected cases; however, the surgical approach would depend on the anatomical findings and the techniques used during your previous procedures. I would recommend an in-person evaluation with a surgeon experienced in facial and neck rejuvenation to determine whether another surgical procedure could provide a meaningful improvement and what approach would be most suitable.

Philip Wasicek, MD · Answer

Hello, 
I'm sorry to hear that you've been disappointed with your results, particularly after undergoing both an initial neck lift and a revision.
Persistent neck laxity following surgery can have several underlying causes, and identifying exactly what is contributing to your concerns is essential before considering another procedure. The appearance of the neck is influenced not only by skin laxity, but also by the underlying platysma muscle, subcutaneous fat, digastric muscles, submandibular glands, and the position of the deeper neck structures.
In some patients, particularly those with a history of significant weight fluctuations, the skin may have reduced elasticity and reduced tissue quality and this may result in more tissue and skin relaxation following surgery. However, persistent fullness or an inadequately defined neck contour may also reflect deeper anatomical structures that were not fully addressed during the previous operations.
A comprehensive structural neck lift may provide additional improvement in appropriately selected patients, particularly if the previous procedures primarily addressed the skin or superficial tissues. However, after two operations, scar tissue and altered anatomy make further revision more challenging, and the potential benefits must be carefully weighed against the risks.
I would recommend an in-person evaluation with a board-certified plastic surgeon who has significant experience in revision neck surgery. Reviewing your previous operative reports and examining the underlying anatomy would help determine whether another revision could meaningfully improve your result or whether further surgery would offer limited benefit.
The goal should be to identify the specific cause of your persistent concerns rather than simply repeating the same procedure.
Hope this helps.

Frank Agullo, MD · Answer

You did not get an underlifted neck. From the side photo I can see that you have a nice angle underneath your chin. There doesn’t appear to be excess neck tissue. What I do see is that your skin quality is crepey. Your skin has fine horizontal lines in the anterior neck and a couple of faint vertical cords. Weight gain and loss with pregnancy can cause this type of change in skin quality.

A neck lift addresses the position of your skin and trims away excess skin. It doesn’t change skin quality. For this reason if you repeat the procedure a third time, more likely than not it will relax again within a few months.

My recommendation would be to obtain operative reports from your first 2 neck lifts and determine if your platysma muscle (thin muscle underneath your skin in your neck) was tightened in the midline and if any deep neck tissues were addressed. If these components weren’t performed in prior surgeries then you could potentially benefit from having a deep neck lift with a platysmaplasty performed once.

If your platysma was already addressed then I wouldn’t repeat any further skin lifting procedures. Instead I would address your skin quality. In my hands that is Morpheus8 treatments (several of them) with or without Renuvion underneath your skin. If there is still a component of neck laxity then this will hold better if the deep neck tissues and platysma are tight.

Realistically the only way to get rid of all of your skin lines and folds is to excise skin. However given your skin quality (which appears thin) I would keep the energy settings conservative to avoid any adverse side effects.

I would recommend an in person consultation with a board certified plastic surgeon that performs deep neck lifts for a standing evaluation, operative reports in hand.

#StayBeautiful,
@RealDrWorldWide

Zoran Potparic, MD · Answer

It is very difficult to comment on your result without series of full face/neck photos and more information about type of face lift you had (anterior without skin excision, platysmoplasty, posterior with skin excision). You may try Botox to decrease muscle activity and see whether that produces the desired improvement. In-person second opinion consultation with a board-certified plastic surgeon with a good reputation in facial rejuvenation is recommended. Good luck.

Thanapoom Boonipat, MD · Answer

I'm sorry you're dealing with this &mdash; it's understandably frustrating after two operations. When laxity returns after a neck lift and a revision, the problem is often not the skin itself. Common causes are the deeper neck structures &mdash; subplatysmal fat, the submandibular glands, the digastric muscles &mdash; or a platysma that has re-separated, and skin that has lost elasticity (weight changes and pregnancy can contribute) will re-stretch no matter how many times it's tightened. Repeating the same tightening operation a third time rarely changes the outcome unless the actual cause is identified first. The right next step is an in-person evaluation, ideally with your prior operative reports, by a surgeon whose neck work addresses the deep neck, not just the skin. Please don't blame yourself &mdash; this is a known hard problem, and it deserves a proper diagnosis before another surgery.

Laxity one year after neck lift - do I need a revision? (Photos)

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