Things are getting worse 6 months after SMAS face and neck lift! Any suggestions? (photos)

Question

Dear Doctors, I had a SMAS face and neck lift with platysma tightening 6 months ago. 1 month after the surgery I wasn’t satisfied but then things went better and 2 months later I was happy with the result. But then things started to getting worse and now I’m disappointed and I fear in a short time I will be almost as in the pre-surgery condition. Do you think surgical technique was wrong? Is a touch-up necessary? If yes, is an invasive surgery like the first one needed? Thanks a lot in advance.

Marc DuPéré, MD · Answer

Thank you for your question.Neck muscles are dynamic muscles and a facelift/necklift will not cancel their contractions.  So they do come back to some extent over time.  I do transect them in the midline when I do the anterior muscle repair - it tends to minimize their returns post-surgery.At this point in time, I would consider Botox or Dysport as those can often take care of those weak and small bands.  Usually 12-15 units per band.I would also add that youe post-op results do look improved.  Some laser resurfacing could be considered too.Best regards.

Martin Jugenburg, MD · Answer

Platysma bands are very stubborn and most difficult to correct in the neck lift/facelift.  I don't think anything was done incorrectly during your surgery, over time these bands tend to come back.  Aside from the bands you still have a nice result.  Your results will continue to evolve over the next few months.  After 1 year you could speak to your surgeon to see if anything else can be done to address your bands.  BOTOX is a great non-surgical technique to minimize these bands.

John J. O'Brien, MD · Answer

Hello, thank you for this question. I am sorry to hear you're having some problems following your facial rejuvenation. It appears that you have some muscular bands that are separated in the midline of the neck. This may not have been apparent during her recovery due to some swelling. I would recommend you discussed this and a potential revisional procedure in your neck with your treating surgeon. Unfortunately, I do not believe your result will get better with time. Best of luck.

Paul Lanfranchi, DO, FAOCOO · Answer

I'm sorry to hear you are so stressed over your procedure.  The reality is that you need to give it 9-12 months before deciding if you are happy with the result.  Undoubtedly your result will change/evolve month to month.  I do think it is a great idea to photo-document your progress (as you have been doing).  Platysmal bands can be stubborn and can return in certain cases.  Deciding if you need another procedure is premature at this point since you still have more healing time.  A revision procedure of the submental neck region (the area under the chin) does have risks such as bleeding and persistent seroma (clear fluid pocket).  Let your surgeon know of your concerns now and be sure he sees you periodically.

John A. Standefer Jr., MD, FACS · Answer

The platysma muscles of the neck play an integral part in neck appearance before and after surgery. They are very active any time you turn your head or neck and more so when you strain the neck. Some muscles are stronger than others. No matter what, when they contract during these movements, it causes a "bow-string" effect. We all want the sharp clean profile after facelift surgery, so the muscles need to be addressed to achieve that goal. Placing sutures into the muscles to tighten them under the chin is a common solution. The truth is, the muscles continue to contract even when you tighten them. If the muscles are too strong, they can pull so hard to pull the sutures apart, or conversely, if they are too thin and weak, they cannot hold the sutures sufficiently to prevent recurrence of the bands. There are techniques that are helpful to prevent the band recurrence, which may be necessary if you and your surgeon decide that a revision is necessary. Discuss these options with your surgeon. John Standefer MD

Things are getting worse 6 months after SMAS face and neck lift! Any suggestions? (photos)

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