What would be the best revision for my face and neck? (Photos)

Please would you advise. I have had a facelift (2012) and two revision surgeries (2013 and 2015) 1st revision was a cut under the chin to tighten the muscles, the second revision was suspending the submandibular glands. Could further surgery make any improvement and what surgery should I look into or are my expectations to high ? Thank you in anticipation.

Doctor Answers 7

Facelift and Revision

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This is a good question.  Your photos are a good start.  It appears that several key surgical decisions were incorrect that lead to the final appearance of your face.  It appears that the skin was draped in the wrong direction and this has lead to the unsmooth draping affect in your jawline and neck area.  This gives that fullness and skin folds that are present.  This can be corrected with proper draping and better placement of the incisions.  The neck area can be improved but it needs to be taken apart again and the correct tightening of the muscles and removing the bands that are present.  It appears from the photos that it was not done correctly at any of the surgeries that were performed.  This can be improved but that would have to be determined after seeing you in person.  It appears that there is still Neck fullness which would indicate fat remaining in the neck area.  Again, only a physical exam can determine this.  The last area is the jowl area that is present. It appears that you still have jowls.  The correct way to improve this is to have a SMAS Face Lift and tighten this part of the face.  This is the proper way to correct the jowls and give it a lasting affect.  The SMAS is lifted and the skin is draped over this in the proper direction.  You can definitely get an improvement if the proper surgical procedures are performed.  The last thing that can be added is Fat transfer.  This can correct any volume loss you may have in the mid face.  Good Luck.

As I always like to add. your face is the diamond and polish it properly the 1st time, and revisions will not be necessary.

Newport Beach Physician
4.9 out of 5 stars 47 reviews

Secondary Facelift and Necklift

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It looks as if the neck is not fully corrected and the vector of the skin flap pull is off, making you have the wrinkles sweeping up to your cheek in an unnatural way. There seem to still be platysma (neck muscle) bands so you could think about a revision from a board certified plastic surgeon and get platysmaplasty (neck lift) and revision of the neck scar that has skin bunched up by it.  Revision of the facellft could be done with re-direction of the vector of skin pull. Special attention should be paid to the neck rejuvenation-- wide undermining and re-draping of the skin flap after lateral platysma flap is pulled and sutured near your ear.  This creates a much sharper neck and jawline, and really is  a critical factor in the success of a face/necklift which can take years off when you are looking in the mirror!  The skin should not be tight at your incision lines, it is the underlying foundation of your face (called the SMAS) that does all the work and is sutured or lifted more. I usually recommend waiting at least a year before any revision of the face or neck in cosmetic surgery. Good luck to you. 

Revision to Original Facelift Years Prior

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Patients who desire facial rejuvenation that is affordable, quick, and effective should consider the Lite-lift™. The LiteLift™ is an innovative facelift developed by board-certified plastic surgeons Dr. Larry Nichter and myself which benefits many male patients. The goal of the #LiteLift is to provide a less invasive natural looking option for both men and women desiring to refresh their appearance with less downtime and risks. The LiteLift® is a “real” facelift, which does address the underlying muscle, tissue and overlying skin.

The technique requires limited incisions and takes a vertical lifting approach, in contrast to the traditional facelift, which requires extensive incisions and lifts or pulls the face towards the ears horizontally. The modern techniques used allow us to perform most LiteLift® procedures in the office under local anesthesia. Also, removing the risk of general anesthesia opens the door for more people to pursue facial surgery. All too often people do not move forward with undergoing the desires facelift surgery due to their overwhelming fear of the risks associated with general anesthesia.

This is a modified facelift that can be performed in the office with a local anesthetic and improve signs of aging around the neck, jawbone and lower face. These procedures are not "Thread-lifts" or "String-lifts". We do not use the "barbed" sutures employed in these other lifting operations. The Lite-lift™ uses longer lasting techniques that are discussed below. Because the incisions are limited, there is less bruising, swelling and healing time for most patients. Many patients can be back to work in one to two weeks looking rested and more youthful.
The best candidates for #LiteLift are non-smoking patients 35-60 years old with stable skin elasticity, well-defined bone structure but showing early changes of the lower face and the neck. Older patients who cannot or do not wish to have a longer operation or general anesthetic can be improved with a Lite Lift™. All in all, Lite Lift™ surgery is individualized for each patient. 

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

Facelift revision

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Hello and thank you for your pictures and questions.

You are not alone! I would suggest that you seek out additional consultations. Perhaps there was a mis-communication with you and your surgeon? While your pictures are not in sequence, I have performed re-do facelifts on patients with similar conditions. As others have advised, you cannot correct a vertical skin laxity problem by pulling the skin backwards. Look at the video attached and it may help you understand why things turned out this way for you. The submandibular glands are difficult to deal with and may  not be the most critical factor  in your current level of dissatisfaction. 

Hope this helps you with your decision going forward. 

Sincerely, Dr K

Michael Kulick, MD, DDS
San Francisco Plastic Surgeon
4.3 out of 5 stars 12 reviews

Facial contouring #fatgrafting #beauty #tmbcosmeticsurgery #woundhealing #facelift #fillers

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Dear kopyto

Thank you for your question and photos! The revision surgery should involve shaping of the deep layer of the tissue ans skin redraping.  You may still see some "sweeping" with tilting you neck down due to changes in skin quality.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

What would be the best revision for my face and neck? (

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My opinion is different. The skin has been pulled tight horizontally. it is loose vertically. I don't think that you can take this amount of skin out in a vertical direction without trading one deformity with another, ie drapery-like sweeps in thecheeks. As you can tell when the neck is extended there is not so much of a problem.

This is largely due to the loss of elasticity of the skin and the strong horizontal pull originally and  subsequent operations. I would be careful about revising this

You can make the submandibular glands better with botox BTW.

Val Lambros, MD, FACS
Corona Del Mar Plastic Surgeon
5.0 out of 5 stars 8 reviews

Face neck revision for the third time

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Very sorry. .... you are not my patient, but I am happy to help

We can all make a mistake, even twice. 

Your result illustrates why this work must be performed properly in the first place.It looks like your first operation failed to re-position your facial skin to a higher level. 

One of the most difficult aspects of consultations with patients who have ageing of their neck comes when I tell them that they must also have an incision in front of their ears in order to raise the cheek/jowl skin.

Your revision result clearly shows what happens when the skin is only pulled behind the ears. It does not work. Trying to improve the aging neck without addressing the excess in the jaw line only makes it worse. Patients do not want to hear this. They are frightened by the word "facelift" and much prefer the word "necklift". Your photo clearly shows how your cheek is "hanging" over the edge of your jaw. 

You surely will not want to hear this, but your neck should be redone properly. The good news is that it can be done.

Were you operated on in an office based setting under "twilight" anesthesia? 

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 32 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.