Face and neck lift and scar revision. (photos)

I had a SMAS face and neck lift 8 1/2 months ago. I am extremely unhappy with the results and want to know what went wrong and how to correct this. I have unsuccessfully attempted to see the plastic surgeon.

Doctor Answers 8

All is not lost - a revision by the right surgeon is the solution!

Hello!Although it's regrettable you're in this situation, I'm confident that it is fixable. Your photos show that the wrong technique was used, (likely) a "skin-only mini-face lift," which is a problem of placing tension on the wrong tissues.  A skin-only lift means tightening skin only, rather than tightening the underlying muscle layer (called the "SMAS" layer). Skin lifts may improve the appearance of wrinkles somewhat but it's always temporary - sagging and wrinkles come back just a matter of weeks or months layer, and "mini-face lifts" don't lift the central face which is where patients need it the most.  The end result is having scars without much of a result.  A proper face lift technique involves separating the facial skin away from the muscle layer as far forward as the central cheeks and smile lines, then tightening the muscle layer of the cheek region, the neck region, and the smile lines. Permanent sutures are required for a permanent result and should be anchored to very strong tissues along the cheekbone and behind the ear.  Once the muscle contour has been improved, then the skin is gently re-draped without tension, which avoids the "wind tunnel" look that is all too common amongst celebrities.  Lifted muscle contours translate to a lifted appearance.  And by placing tension on the muscle layer, and not the skin, your lifted contours look natural and not over-pulled.Since your photos demonstrate no discernible improvement, then likely the muscle was not addressed (even if it was addressed, it certainly was not addressed to any significant degree).  Although understandably distressing, this is correctable with the right surgeon at the helm.  I recommend revision face and neck lift with SMAS tightening or SMAS flap.  For overall facial balance and harmony, I'd also recommend lower blepharoplasty and facial fat transfer in order to restore lost volume, smooth facial contours and improve the eye area, and finally a brow lift to soften the deep frown lines and brighten your eyes. Look back at photos of yourself from 15-20 years ago - while the goal of surgery is not necessarily to erase every crease and wrinkle, it is reasonable to expect an refreshed appearance from years ago.  Be careful in selecting your revisionist surgeon as board certification in plastic surgery, face lift experience and aesthetic training (and talent!) are critical to ensure a great result. 
All my best in your search!- Dr. Rad


Washington DC Plastic Surgeon
5.0 out of 5 stars 48 reviews

Facelift

I believe it is the responsibility of the surgeon who performed the surgery to do the follow up and you need to discuss all your concerns in a calm non-accusatory manner.If his/her analysis and plan of care is not satisfactory, then you need to seek an in person consultation with a Board Certified Plastic surgeon.Before the consult write down all your questions and concerns. These should be answered after the consultation and the examination and a plan of correction and expected results.

Samir Shureih, MD
Baltimore Plastic Surgeon
4.2 out of 5 stars 7 reviews

Scar revision will help

Scar revision will help in the incision lines.  The scars are hypertrophic and have spread.Usually the original surgeon will help you with this, or you will need a second opinion.

Facelift concerns

From your photographs, I can understand your concern. A redo of your facelift, probably with more extensive skin separation and placing some tension on the underlying structures would be able to remedy this problem. I would recommend that you see your operating surgeon first and see if they feel like they can correct it.If not, I would seek consultations from other qualified Cosmetic Plastic surgeons in your region. Best of luck.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 44 reviews

Post facelift scars

Hi - it looks as though you have developed some hypertrophic scarring after your facelift.  This is separate to the issue of whether you have had a good result from your surgery.  Hypertrophic scarring can be unpredictable and can occur even to the most experienced surgeon.  There are treatment options available and as with the other surgeons on here I would recommend you continue trying to contact your surgeon.

Good luck

Scarring and result after facelift

I agree with the consensus.  You have hypertrophic scarring that has developed along the incision which can be fixed with scar revision.  It is rather unusual that you haven't been able to see the operating surgeon - I suggest you contact either the office manager or surgical scheduler (whomever you were in contact with prior to your surgery) and see about having them personally schedule you in to see your doctor. You should air your concerns and discuss things in detail with him as they really should be seeing you in follow up anyway.  If you are still unsuccessful or are getting mixed messages and not a clear plan,  seek a second opinion.  Best of luck.

Miguel Mascaro, MD
Delray Beach Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Scar formation after facelift

Hello gwcharley and thank you for your question. It is unfortunate that your attempts to see your plastic surgeon have been unsuccessful. You do have options for improving the scars around your ears, but an in person evaluation is usually advisable. Options may include simple injections vs laser vs excision. Be sure to find a board certified physician with extensive facelift experience.

Unbfavorable scars after facelift

It looks like you have developed some hypertrophic scars in the area.  This can happen to some individuals and is often related to their genetics in terms of healing. Sometimes scar revision may be helpful.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.