If a revision is done, where would the new incisions be to smooth out skin folds? (Photo)

Question

These pictures are at 3 months; I am now 4 months but not much change. I want to know if this requires behind the ear along the hair line or from back of ear to hairline incisions to repair these folds. Also how long do i need to wait to get this done. My surgeon says he has no photos to show me which worries me that he has not done this before.

Paul Lanfranchi, DO, FAOCOO · Answer

Thank you for sharing your concerns.  It is relatively common to have some temporary bunching of skin behind the ears after a lower facelift.  Typically once the swelling goes down completely (6-9 months at times), the fullness and line that currently appears are much softer in appearance.  That said, based on the length and placement of the initial incision, it is possible that IF you need a bilateral (aka both sides) revision, the incision would be placed higher into the hairline (behind the ear) and further down along into the scalp.  This would bring the entire incision higher (while smoothing out the current fullness...if it had persisted) allowing it to be camouflaged perhaps better.  Your actual neck and jawline result is quite good.  So for now please give it a few months before deciding to address surgically.

Amir Nakhdjevani, MBBS, MRCS, FRCS(Plast) · Answer

Thank you for your question.This is extremely normal to have 'skin bunching' after a lower facelift, this is so, when you heal fully over the next coming months, this should even out. Always wait until the fullest time possible to heal as you will notice these creases even out in due time. It's always good to let the patient understand fully why your particular surgeon has done things in a certain way, which gives you reassurance in this time. After 6 months and this hasn't improved, consult your surgeon and he may need to look into what the next steps could be, should he need to make any kind of revision surgery, if required.Good luck!

Mike Majmundar, MD · Answer

Skin folds for the first 3-4 months can occur and are usually a result of collagen formation that heals the deeper tissues after the skin heals.  Based on your photos, it appears that you  may need a longer incision behind the ear to smooth out the folds that are persisting though I would wait a few more months before pursuing this course.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about facelift revision.Yes, it is possible to revise the pleating of facelift scars. The scar is typically located along the back of the hairline.To be sure, see two or more board-certified plastic surgeons in your area for a full and complete evaluation to make sure you are a good candidate and that it is safe for you to have facelift revision.I hope this helps.

Evan Ransom, MD, FACS · Answer

Generally, facelift incisions are planned in the hairline or immediately behind the hairline. It seems that yours were not placed in an ideal position. That said, with time, these will fade and may become much less obvious. I strongly encourage patients to wait 9-12 months before embarking on any kind of scar revision. In the meantime, some lasers can be great for speeding up the scar remodeling process. For example, the 1540nm Erbium laser.

Jonathan Kulbersh, MD · Answer

While I agree the facelift inicisons could have been placed in a better position, I believe these areas may continue to improve overtime.  If you are able to tolerate it, I would wait at least another 6 months to see if the areas will improve.  This may heal to a point where you do not require additional surgery.  Facial incisions will continue to heal for 1 year after surgery.I hope this helps.

Raymond E. Lee, MD · Answer

Thanks for sharing.  It appears that you have some excess skin causing the bunching. This can be remedied surgically requiring existing incisions and incisions that would travel down a bit further along the posterior hairline.  This will allow the excess skin to be lifted, advanced, and removed.  I do also believe your incisions can be placed closer to the hairline to hide them better.  Temporarily growing your hair out longer will help to hide the incision  As a surgeon i would wait at least 6 months before the revision work.  This can be done under local anesthesia as well.

Vincent N. Zubowicz, MD · Answer

Incisions for correction of the redundant skin of the neck would extend above the hairline posteriorly towards the back of the neck. Generally, when well healed, they are very inconspicuous.

Toby Mayer, MD · Answer

Scar revision for facelift scars with pleats. This will need an incision from the back of the ear and down the hairline. If you go into the hair you will "step the hairline". I do not see any advantage to waiting at this point since this may get smaller but still need revision.

Gustavo A. Diaz, MD · Answer

I would still recommend to wait until the 6 months mark. Incisions many times improve with time. If they do not; then a touch up procedure to redistribute the skin in a less noticeable fashion can be done to improve the current problem. Hope this helsp,Dr. Gus Diaz

If a revision is done, where would the new incisions be to smooth out skin folds? (Photo)

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