Could revision surgery help "tuck-up" my hanging skin? Who does revision facelifts in DC/Baltimore area? (Photo)

Question

I had an SMAS facelift/neck lift on 6/30/16. The surgery did not give me the strong jaw and 90 degree neckline I had expected. When questioned, my surgeon said he could not pull my skin tighter because of my salivary glands' location, and a revision would not help. He suggested Kybella (though I didn't understand why - it is hanging skin, not fat). I went along (for another $1500) because I trusted him. So far all I've gotten is swelling, crepey skin, and a very bad neck rash. I am 64 years old and obese.

Houtan Chaboki, MD · Answer

Facelift surgery is better to address loose skin and sagging muscle. Kybella can reduce neck fat gradually over time. However, Kybella doesn't lift the neck or tighten the skin per se. Revision facelift surgery can be considered once appropriately healed from the last procedure. Based on the limited photograph, it's difficult to determine appropriate possible options.

Ronald Schuster, MD · Answer

I'm sorry to hear that you did not get the results you were looking for. It looks like loose skin to me. If so you will probably need a complete re-do.

Benjamin C. Marcus, MD · Answer

HiIt looks like you have some excess skin of the sub-mental region. Sometimes this happens when the in-elastic skin of that area does not drape ideally after some of the deeper tissue is tighter. It does not look like it is due to the sub-mandibular glands which have a very particular appearance. In our practice we would suggest a full-re-draping of the neck skin potentially via a deep plane technique

Steven Wallach, MD · Answer

It looks like you would be a good candidate for a revision facelift with loose skin.  I do not like to remove salivary glands because it may lead to dry mouth and it increases the risk of complications of hematoma.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts on women in their late twenties and early thirties.  From the photos your cheeks are flat in the front, there is significant excess fat in the mid face/lower face and neck, jowls are present and there is significant loose skin in the neck.   
 Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
  If you have "jowls” these are sagging facial tissues and an indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular facelift is the minimally invasive, short incision facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed
excess skin removed
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.
 Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess, in your particular case by about 60%.
 If the maximal amount of neck skin is to be removed, a "formal" neck lift can be done together with a lower facelift.  In the latter, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
This is an extensive surgery taking 4 1/2 to 5 hours with larger incisions, pressure dressing, post op drains and a longer recovery. 
Hope this helps.

Could revision surgery help "tuck-up" my hanging skin? Who does revision facelifts in DC/Baltimore area? (Photo)

Answers (5)

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