What can be done for neck lift puckering under chin & is numbness permanent? (Photos)

Question

Approximately 1 year ago I had a facelift, necklift and upper and blepharoplasty. At this time I still have numbness on the left side of my face from ear to mid-face. In addition, I also have puckering under my chin. Two questions is the numbness permanent and what can be done about puckering. From pictures you can see left side of chin below mouth doesn’t move as much as right.

J. Timothy Katzen, MD, FACS · Answer

Hello COLLIER1960 in Redlands,
Thank you for reaching out with your concerns about puckering under the chin and numbness following your facial surgery, including a facelift, neck lift, and bilateral upper and lower blepharoplasty, which took place a year ago. Let's address each concern separately:
Numbness: One year post-surgery, the likelihood of full nerve sensation recovery can vary. Numbness following such procedures can indeed result from nerve disturbance during surgery. While some degree of sensation often returns, complete recovery may not always occur, especially if significant time has elapsed. To potentially aid nerve recovery, techniques such as gentle massage, electrical stimulation, or vibration therapy can be employed. These modalities might help stimulate nerve function, though they do not guarantee full sensation restoration.
Puckering Under the Chin: This issue can sometimes occur after a neck lift and might be related to muscle activity or scar tissue formation. One treatment option to consider is the use of Botox injections. Botox can temporarily relax the muscles contributing to the puckering, providing a smoother appearance. This approach can be particularly effective if muscle activity is the primary cause of the puckering.
For both concerns, it's important to continue follow-up care with your plastic surgeon or a qualified specialist in facial plastic surgery. They can offer tailored recommendations and treatment plans based on your individual healing progress and the specifics of your surgical procedures.
It's crucial to discuss these postoperative changes with your surgeon to determine the most appropriate course of action and to understand the potential outcomes of any additional treatments.
I hope this response provides helpful guidance regarding your postoperative concerns and potential treatment options. Please reach out to your healthcare providers for further assistance and personalized advice.
Wishing you the best in your ongoing recovery.
Sincerely,
Dr. Katzen

Gianfranco Frojo, MD · Answer

The numbness is quite common due to the superficial nerves sometimes being temporarily disrupted; it usually resolves by 12-18 months as the nerves are capable of regenerating unless they are completely transected. It appears that you do not have enough innervation from the left marginal mandibular nerve injury (this is a branch of the facial nerve) that provides motor firing to the lower lip depressors (this is why your smile is asymmetric). The main problem in the neck is that the incision is not in the ideal position, and the underlying muscle is starting to separate again.  I recommend seeing a plastic surgeon with at least 6 years of integrated plastic surgery training and ideally an additional year of aesthetic surgery fellowship training.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Ryan Rebowe, MD · Answer

Unfortunately, the numbness on the face is likely permanent at this point if you are one year out. In terms of the tethering, that scar can likely be release either under local anesthetic or under anesthesia. This may involve an open incision or could involved separating the subcutaneous scar with a needle. However, in either case, it is possible for the tethering scar to return following these revision procedures.

Philip S. Schoenfeld, MD, FACS · Answer

The easiest problem to address would be the puckering under your chin.  Unless the submental area was significantly defated and there is scarring of the skin,  a short revision of the neck incision with undermining of the skin under local anesthesia should help.  Numbness and weakness are likely due to injury to two different nerves.  The marginal mandibular nerve is creating the weakness of the lip for depression and likely the Greater Auricular nerve is creating numbness to the effected ear.  The numbness on the side of the face is a bit of mystery however.

Derek Fletcher, MD · Answer

The puckering under your chin is likely related to the platysma muscle repair. The amount of visibility may be due to excessive thinning go the subcutaneous fat in that location. Numbness after surgery can continue to recover for two years, so there is a chance your sensation will improve. The weakness of the corner of your mouth is due to an injury of the marginal mandibular branch of the facial nerve. Minor injuries to this nerve typically recover in the first few weeks to months. However, if the nerve has not shown significant signs of recovery by 1 year, it may not recover.

All of these issue should be discussed with your surgeon. Best of luck in your recovery.

All of these issue should be discussed with your surgeon.  Best of luck in your recovery.

Darryl J. Blinski, MD · Answer

Thanks for the few posted photos. Seems you had a poorly preformed full face/neck lift with complications of in adequate neck dissection (causing puckering), Greater Auricular nerve damage on left side (causing numbness), also appears in photos damage to left (?) marginal mandibular motor nerve to lip depressors. Best in person or detailed virtual consult ASAP.

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