Should I still have a crooked smile and thickness under my chin 4 weeks after Neck Lift and Liposuction under the chin?

Question

The hard thick area under my chin has left me with a square jawline instead of an oval shape to my jawline which I once had. I have worn the pressure garment diligently.

Douglas L. Vander Woude, MD · Answer

Thank you for your question.  Some patients can experience irregular contours or firmness after liposuction in any area.  It might represent a small area of bruising that is in the process of resolving.  That can take a few weeks.  Patience is helpful.  
Occasionally, there can be enough swelling in the area to cause the smile to appear a bit asymmetric.  That will resolve as well.  Much more rare, would be an actual facial nerve branch injury causing the smile problem.  If it is not improving over the coming weeks, you should review that with your surgeon for more advice.  Best of luck.

James Bonaparte, MD, MSc, FRCSC · Answer

Thanks for your questionWith respect to your smile, there is a chance that the nerve that runs under your jawline was stretched or bruised. This almost always returns to normal, but it can take some time (I posted a link below with some more info on this). The fullness is normal after a neck lift and again, can often take months to fully resolve. Be sure to have your surgeon monitor it over time,James Bonaparte

John Mesa, MD · Answer

Patients with questions and concern about their neck lift healing should contact the plastic surgeon that performed the procedure to address these concerns and determine if there is need any need of management.

Jason Emer, MD · Answer

It is too soon to tell what your final results will be. You most likely have swelling, which can last 3-6 months after your procedure. To speed up healing, you can try adding hyperbaric oxygen, lymphatic massage, venus legacy or exilis radiofrequency treatments. To improve final results, we will often do a kybella and ultherapy about 4-6 weeks after neck liposuction to get more of an outcome. See an expert. Best, Dr. Emer

David Gilpin, MD · Answer

Thank you for your question.  While it is difficult to assess exactly what is occurring without a photo, it sounds as if thickness is within the normal limits of healing.  After a necklift and liposuction, you will have quite a bit of swelling under the chin and around the neck.  This is secondary to the surgery itself and also because of any sutures which are dissolving under the skin.  With time, this swelling and thickness should soften and resolve. Be sure to discuss your concern with your surgeon, as only he/she knows exactly what happened during your procedure. I hope that this helps!-David Gilpin

Nelson Castillo, MD · Answer

Thank you for sharing your question and congratulations on your neck lift procedure.  Without photographs it is difficult to offer definite advice but at four weeks you may still be experiencing tissue swelling that is widening your face, masking your long-term results.  This should improve given enough recovery time.  Voice your concerns to your surgeon, they are in the best position to help reassure you.

Jordan Rihani, MD · Answer

If you had a necklift, expect swelling to go away gradually, usually over a period of 2 months. This may depend on the amount of liposuction or muscle tightening done on the front of the neck. In regards to the smile asymmetry, you may have some nerve weakness from your surgical procedure or liposuction. If it is just weakness, then it should improve gradually as you continue to heal, but your surgeon would be able to provide a better estimation of this.

Inessa Fishman, MD · Answer

A crooked smile after a neck lift may indicate an injury to the marginal mandibular nerve, which innervates some of the muscles around the mouth.  In my experience, this injury is usually temporary, and the nerve can take a few weeks to 6 months to recover; treatment is tincture of time.  A permanent nerve injury is much less common, and is quoted as ~1% in the surgical literature.  The thickness underneath the chin most likely represents swelling, though muscle banding, developing scar tissue, or a small collection of pooled blood are other possibilities.  Swelling and developing scar tissue are typically well-treated with steroid injections, though lymphatic massage and ultrasound treatment can also be helpful.  You would do well to keep in close touch with your surgeon, both for follow-up care and reassurance.  Good luck in your recovery.

Mats Hagstrom, MD (license on probation) · Answer

A crooked smile after face or neck procedures is often indication of injury to the buccal branch of the facial nerve.
This branch innervates the Orbicularis oris muscle. That is the lip muscle.
Since it's usually only one side that's involved in the injury(it's highly unlikely he that both sides would be damaged during a single procedure) patients can be left with asymmetrical smiles.
When this happens from liposuction the nerve often heels and the smell comes back to normal.
When done with open surgery such as a facelift or a neck lift the nerve could be cut and recovery is not always complete.
Regardless, you need to be patient and wait.
Recovery can take as long as a year.
It's hard to say what the firmness represents represents without an examination.
Follow up with your doctor I share your concerns.
He or she should address them honestly, give you reassurance and what you should expect in regards to recovery.
Best,
Mats Hagstrom, MD

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