Loose skin under chin - what now? (Photo)

Question

I had a facelift 6 months ago. Since then, gradually, this skin under the sides of my chin has gotten looser. It looks very unappealing. I spoke to my surgeon who insisted that it looked better than before so I should be fine. Eventually, he said he could tighten the skin by making incision under my chin. I am reluctant to do that. What are my options? Should I have the revision?

Gianfranco Frojo, MD · Answer

This is a classic presentation (Cobra neck deformity) after certain maneuvers/techniques performed in facelift/necklift. There was excessive removal of the midline fat in between the platysmal bands. The prominent bulges in the lateral part of the neck are the submandibular glands. It also appears the jowls were under-treated or recurred rapidly. The solution is to remove the submandibular glands and any excess deep fat in the neck followed by bringing the edges of the platysma muscles together while eliminating the bands (deep plane neck lift with platysmaplasty).  This is only my professional opinion based on the photos, A true physical exam would be beneficial. I would recommend seeking a consultation with an experienced American Board of Plastic Surgery with extensive knowledge of aesthetic surgery. Ideally, this surgeon has completed an Aesthetic Society accredited aesthetic surgery fellowship.

Raffy Karamanoukian, MD, FACS · Answer

Ultherapy is a non-invasive procedure that lifts the neck, chin and brow, and improves lines and wrinkles on the upper chest. As we age, collagen breaks down, resulting in loss of skin strength and elasticity. For tissue tightening, Ultherapy is ideal for the lower face and neck and we often combine it with CO2 laser or Morpheus8 to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Anil R. Shah, MD · Answer

Based on the photos, this is a classic area where necks often show signs of weakness, particularly in the submandibular triangle. It's a fairly common issue where patients may initially look better because they try to lift up the face. However, over time, as the face naturally settles, some laxity in those corners might become noticeable. I don't recommend making an incision under the chin. If it's soft tissue, you can consider an incision underneath your chin. However, the best option would be to explore other methods to reposition the skin and ensure that all areas of fullness in the submandibular triangle are adequately addressed. There are multiple surgical and non-surgical approaches to fixing this. It's always advisable to consult with a facial expert for personalized advice. I'm sorry to hear about your experience.

Ronald J. Edelson, MD · Answer

When you had your facelift done was an incision made under your chin?  If not it appears you would benefit from tightening the neck muscles with an incision under the chin as your surgeon discussed

Kenneth R. Francis, MD, FACS · Answer

Dear suzi62,
It's a little bit difficult to determine what the source of the "loose skin" is under your chin.  It may be in fact loose skin.  It may be muscle bands.  And it may be that your submandibular glands are now more visible since your skin tightening.  These differences can only be assessed in person.  Submandibular gland removal is a higher level of facelift surgery and sometimes isn't recognized as necessary pre-operatively.  Even when it is, many surgeons avoid it because the risks for bleeding and nerve injuries are higher.  Have this discussion with your PS and good luck!

Darryl J. Blinski, MD · Answer

Based on your nicely posted photos, it appears you have sub mandibular gland laxity with possible skin laxity either Botox into the submandibular gland in 3 to 6 sessions over a 4 to 6 month period or complete open NekliFF with muscle repair of the submandibular gland area is indicated best to virtual consulate expect fee for the range $25,000.

Loose skin under chin - what now? (Photo)

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