I had a high SMAS facelift 9 months ago. Concerned this is cobra neck and my Perioral mounds

Question

Do I need a revision (platysmaplasty)? Was the Smas in the lower face not tightened enough as I have Perioral mounds Perhaps a vertical vector? The Dr was going to tweak the smal ft under my right eye and add more fat to my cheeks noselabial folds lips and chin as this is where I had fat and a second round is needed. He also suggested Buccal fat removal and lipo filling to the Perioral mounds. But I want a permanent solution and wonder if a revision would reposition the SMAs for long lasting

Brian K. Machida, MD, FACS · Answer

The mounds in the neck under the chin indicate possible subplatysmal muscle prominence possibly of the anterior digastric and the submandibular salivary gland.  Most platysmaplasties do not address those prominences, and many surgeons do not perform that procedure routinely with a lift.  As far as the perioral irregularities and the red dot on your upper lip, it's difficult to tell what was done.  Was there micro liposuction done there? If so, it needs to settle down. Sometimes, lateral perioral mounds may be muscle prominence in thin patients, but I can't tell from the pictures at this point.

David M. Kowalczyk, MD, MBA, FACS · Answer

Hello! Sorry that you've experienced trouble with your neck lift results. Cobra neck deformities occur when too much fat is take from the submental area and/or the correction of the platysma in the midline is inadequate causing banding to the sides This can be a difficult problem to correct but not impossible. A revision of the platysmaplasty with some form of fat grafting, if needed, can improve the area a lot. I would revisit with your surgeon if you're comfortable. If not, seek consultation with another to determine what is possible for improvement. Best of luck!

Joseph Shvidler, MD · Answer

Cobra neck deformity can occur when too much superficial and deep fat is removed in the central sub-mental area and lateral  sub-platysmal areas may not have been addressed.  This can be due to the residual lateral fat deposits and  medial platysma muscle that either dehisced or  has not been plicated. This can also occur if there are prominent digastric muscles and ptotic submandibular glands.  High SMAS technique addresses lateral face the lateral cheek and defines the jaw angle but does not address the central sub-platysmal area. You are likely looking at needing to revise the neck and address the above areas

I had a high SMAS facelift 9 months ago. Concerned this is cobra neck and my Perioral mounds

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I had a high SMAS facelift 9 months ago. Concerned this is cobra neck and my Perioral mounds

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Everything you need to know about Neck Lift

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