What’s the best option to fix this splitting neck lift? (photos)

Question

Had a deep plane neck lift/lipo in 2020 (age 34). Now (age 38) it appears the sutured platysma muscles have split in 2. Original surgeon suggested an in-office procedure to cut into the existing chin scar, & remove some of the platysma muscle (myotomy). And maybe make a 2nd incision to re-suturing the splitting muscles. I wanted to get some other opinions on ways to correct this. Does this sound reasonable? Or should I be looking into a full on neck revision?

Gianfranco Frojo, MD · Answer

This is a cobra neck deformity. This is related to excessive removal of the deep fat in between the platysma muscle bellies in the midline of the neck followed by dehiscence (separation) of the two platysmal muscle bellies from the midline repair. It does not appear that the submandibular glands were reduced. It also appears that the platysma muscle has separated and there is now a gap out of the midline. I would recommend a deep plane neck lift to reduce the deeper fat further, sculpt the submandibular glands, repair the platysmal muscle bellies back together and very carefully perform superficial fat liposuction. The superficial liposuction of the fat immediately below the skin needs to be very conservative as this fat is critical to having smooth, shiny and normal looking skin. You need to find an American Board of Plastic Surgery certified surgeon; ideally, this surgeon has also completed an aesthetic fellowship accredited by the Aesthetic Society.

Dilip D. Madnani, MD, FACS · Answer

Pictures of you looking up and down and seeing how much fullness there is in your neck would also be helpful, as you may need a deep neck lift to further improve the area, which may include reducing some of your glands and tightening some of the deep muscles and removing some of the deep neck fat, along with tightening the platysmal bands that you have that have loosened.

Zoran Potparic, MD · Answer

It is very likely that full anterior neck revision would be more appropriate than new platysmaplasty;  deep and superficial fat deposits need to be reduced and shaped, very likely submandibular glands and possibly digastric (deep muscles) as well. You may be a candidate for posterior extended neck lift in order to further tighten platysma and remove some skin from your neck. Scar is placed entirely behind the ear. Lower face, neck lift may be also a valuable solution rather than small gains with limited anterior lift revision. Consider second opinion consult with one or two experienced board certified plastic surgeons experts in facial rejuvenation before making final decision. Good luck.

William Portuese, MD · Answer

There are several issues in your neck that are gonna need to be addressed based on your current photographs, so this will require an in-person examination. A revision neck lift would include liposuction to remove the fat deposits above the muscle, surgical extraction of any fat deposits below the muscle, trimming back a portion of the digastric muscle, and possible trimming of the submaxillary glands bilaterally if they are the cause of the bulging. You will also need a provision plasma plasty as well. You also have a recessive chin profile, so consider placement of a small chin implant to augment your chin forward which will also give you better structural support for the soft tissues in your neck.

What’s the best option to fix this splitting neck lift? (photos)

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