What can be done to improve my lumpy neck skin? (Photo)

Question

I had a platysmaplasty in September 2020 but by mid 2022 my platysmal bands were showing again and I had some loose skin . I went and had a partial resection at the end of November 2022 however my neck is still a little lumpy and looks like this . The surgeon has reviewed and said issue might be scar tissue and hyperactivity of the platysma muscle and suggested Botox and an injection of Kenalog steroid . Advice needed

Joshua T Halka, MD · Answer

Hello,
I agree with your surgeon, if you had some of the platysma resected or cut during your procedure and it still is bothering you, using botox to weaken the platysma and addressing the scar tissue with steroids is a good idea.
Dr. Halka

Nelson Lee Novick, MD · Answer

If there is indeed platysmal hyperactivity, Botox would be a reasonable approach. It is a fairly common approach for neck rejuvenation that has been dubbed the "Nefertiti lift."  Of course, if the lumps are indeed fibrous nodules secondary to the surgeries, the use of intralesional triamcinolone would serve to shrink these. However, the kinds of bands and vertical cords seen in the photos is quite common with the passage of time, and, if this is simply the case, then the expert use of a robust HA lifting filler injected laterally on both sides in a semicircular fanning fashion in order to lift and pull the sides of the neck (tightening the central area) accompanied by small, superficial boluses of a low viscosity, cohesive, malleable HA filler for the central portion of the neck in a grid pattern would help to tighten and smooth this area. You would be wise to make certain to consult with an experienced, board certified cosmetic dermatologist filler expert. Best of luck.

Jason Emer, MD · Answer

​I find that VASER liposuction in combination with Renuvion or ThermiRF are best for contouring the chin in those who are candidates, but Kybella can be used as an alternative and gets better results when combined with Thermage/Ultherapy/Exilis, TruSculpt iD, or Coolsculpting. I recommend getting a formal evaluation with an expert. Best, Dr. Emer​

Brian M. Harmych, MD, FACS · Answer

The skin contour irregularities are unlikely to improve with time and nonsurgical treatments such as steroid injection. Unfortunately, this problem requires revision necklift and lower facelift to correct. Additional surgical correction is needed in the deeper neck tissues. You may need some reduction of the deep neck musculature (digastric muscles) and perhaps even some reduction (not removal) of the submandibular glands to completely correct these issues. These problems are the second most common (not far behind a failed "mini lift") reason a patient presents to my office for consultation on revision necklift or revision facelift.

John B. Roach, Jr., DO · Answer

There appears to be a scar contracture along the right side of the neck and may benefit from subcutaneous release with a neck lift revision.

Venkata Puppala, MD · Answer

Hello, and thank you for reaching out. I understand your concerns, and I’m here to offer some guidance.
It sounds like you’ve had a couple of procedures for your neck, and the lumpy appearance you’re describing could indeed be a combination of scar tissue and increased activity of the platysma muscle. Both of these are common issues following surgery, but fortunately, there are treatments that can help.
Here’s what I recommend based on what your surgeon has suggested:
Scar tissue: Steroid injections, such as Kenalog, are often used to reduce the size and appearance of scar tissue. These injections can help soften and flatten the lumps caused by the scar tissue. It’s important to monitor how your body reacts to these treatments, especially if you’re prone to keloid formation. Further surgeries should generally be avoided if you’re prone to excessive scarring, as this can make the problem worse.Hyperactivity of the platysma muscle: Botox can be very effective at relaxing the platysma muscle if it’s becoming too active and causing bands or tightness in the neck. By injecting Botox into specific points of the muscle, we can reduce this hyperactivity, which should improve the overall smoothness of the neck area.In addition to these treatments, if you’re still experiencing some loose skin, there are non-invasive skin tightening treatments like radiofrequency or ultrasound-based therapies that can help improve the firmness of the skin without the need for more surgery.
I hope this explanation helps clarify things! I would recommend following up with your surgeon to discuss the timing and plan for these treatments, and how they can be tailored to your needs. Please don’t hesitate to reach out with more questions or if you’d like more details on any of these options.

Susan Van Dyke, MD · Answer

Reappearance of neck cords after neck surgery can happen. The muscles can become overactive and cause the edge of the platysma to be visible.  It is easy to do a trial treatment of Botox (or any of the other neuromodulators: Dysport, Xeomin, Jeuveau, Daxxify). The treatment will relax the muscle and if the appearance is improved, you have your solution.  If there is also scar tissue, intralesional steroids and 5 fluroruracil will soften the scars and also improve the result.  Because the neuromodulators work quickly, it might be best to try them first. Steroids can take weeks for results where neuromodulators take days.

Adam Goodwin, MBBS, FRCS(Plast) · Answer

sadly, as your neck ages the platysma muscle gets thinner and stringier. Tightening it in any particular direction can make the situation worse, creating stringing or bands.

The difficulty is most additional surgery further tightens the platysma, which predisposes to this stringiness. If you see most celebrity facelifts, they exhibit some degree of this problem.

I agree with your surgeon, more surgery will possibly make this worse and I think Botox is a reasonable option, but maybe something you need to continue with.

I discuss this problem and others on my YouTube channel Adam goodwin surgery  if you are interested.

Best wishes, Adam, Goodwin.

Christopher C. Lo, MD · Answer

On the image, there appears to be pronounced platysma bands (vertical and become more pronounced with grimace). These vertical platysma bands can be treated with botox, which will need to be repeated every 3-4 months.
The incision you have can further be treated with injections (kenalog, 5-fluorouracil). Laser is another potential treatment to minimize the scar appearance.
An in person exam with a specialist will be the next step.

Leonard Grossman, MD · Answer

In patients who have issues just like you do, some of the best approaches are the use of either Kenalog injections or an open revision of the neck. You need to be evaluated in person to determine what method would work best for you the skin and the tissues have to be literally touched by a plastic surgeon. Based on your plastic surgeons opinion, it’s not a bad idea to start with Kenalog injections. If that is unsuccessful, revision surgery might be necessary. I hope this helps and good luck from New York City Plastic Surgery.

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