Neck lift options. Can I avoid nerve damage? (Photo)

Is there a procedure that would address my neck and marionette lines that does not involve an incision near the trigeminal facial nerve? I have residual nerve damage(pain mostly) to my mental nerve from implant that I had removed 5 years ago after only 3 months, and I am now a little gun shy. I want to proceed with something, but I am nervous about nerve damage.

Doctor Answers 10

Neck Options

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Recommendations to Improve your neck appearance depends on your exam - Your plastic surgeon will evaluate you for four main features:

1.Amount of excess fat (needs lipo or direct removal).
2.Presence of Significant Platysmal Banding (requires playsmaplasy or Botox)
3.Amount of excess Skin and condition of your skin. For example younger age, darker skin colors and no large weight loss history means there will be better elasticity and therefore better post surgical contraction. In milder cases if not too much fat is present there will be enough skin shrinkage with just lipo alone. However for moderate and severe skin redundancy a neck lift or lower facelift is needed with or without lipo for best results. Mild to minimal skin tightening using non surgical means like the Sciton Laser SkinTyte procedure, Ultherapy or Thermage could also be considered.
4. Chin deficiency (without adequate chin support your neckline will suffer)

When these procedures are performed by a board certified plastic surgeon the risk of nerve damage is uncommon.
In your particular case,  though an exam is needed for confirmation, based on your photo is a Lite Lift or MACS lift with or without a platysmaplasty procedure.

Lasers such as the Sciton BBL SkinTyte, or even IPL afterwards could be used for maintenance of your results.

Nerve damage with a facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Sorry to hear that you had problems with your chin implant.  Facelift incisions are not in the vicinity of the nerve that is still causing pain and should not cause any problems.  Best of luck!

Konstantin Vasyukevich, MD
New York Facial Plastic Surgeon
4.9 out of 5 stars 51 reviews

Trigeminal Nerve Injury and Neck Lift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
  The nerve that was injured during your chin implant was the mental nerve.  The nerve is located on the chin and supplies sensation to the skin of the chin and lower lip.  During a neck lift, this nerve is not located in the area of the surgery and should be safe.

 There are other nerves that can be injured during a neck lift.  They are:

1)  Sensation nerves
2)  Motor nerves

 Sensation nerves are the nerves most commonly injured during a facelift.  If they are damaged, it can cause numbness to the ear or skin of the face.  The most common of these nerves to become injured is the great auricular nerve.

  The facial nerve is the motor nerve that can be damaged during a neck lift.  It innervates the muscles that move the face.  An injury to a branch of this nerve is the most feared complication of a neck lift, but it is exceedingly rare in proficient surgeons.  

 You are smart to ask these questions.  I hope this helps.  

Trigeminal nerve risk

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
There should be little if any risk to the mental nerve during a face or neck lift procedure. In general, these operations focus on the areas under the skin and fat of the face and neck which are far mor superficial than the jaw bone areas you are describing.

Gustavo E. Galante, MD
Schererville Plastic Surgeon
5.0 out of 5 stars 55 reviews

Neck lift options. Can I avoid nerve damage?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
As well you should be! Best to use HA fillers for facial rejuvenation. And possible neck lifting is the best way to address the neck bands... 

Trigeminal nerve not at risk with a necklift/facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
The trigeminal nerve that was injured during your oral surgery travels in the mandible (jaw bone) and exits the anterior portion of the bone to supply sensation to the lower lip (mental nerve). This nerve is not anywhere near the incisions or areas of dissection for a facelift/necklift. The nerve most commonly injured in such surgeries is the great auricular nerve, which supplies sensation to the ear. If injured, there is usually not a pain syndrome associated with it. The most worrisome injury with a necklift/facelift is injury to the facial nerve, which is a motor nerve, not a sensory nerve like the great auricular and trigeminal nerves. Injury to this nerve results in facial paralysis and is the most feared complication from these surgeries. Your trigeminal nerve would be safe with either a facelift or a necklift. 

Theda C. Kontis, MD
Baltimore Facial Plastic Surgeon
5.0 out of 5 stars 42 reviews

Nerve injury

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
Thank you for your question and concerns.  Nerve injuries with facelift procedures are rare though they are a known risk.  The commonest injury is to the greater auric ulnar nerve that is sensory, injuries to branches of the facial nerve (motor to the face) are less common.  A certain amount of temporary sensory change can be expected just from the undermining for the procedure but all this should be discussed at your consultation 

Dr Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 65 reviews

Nerve Damage with Facelift

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I understand your concern, however, mental nerve damage after a mandibular implant is quite rare but decidedly more common that facial nerve damage after a facelift, which is what you need to correct your neck, nasolabial and marionette folds and cheeks. Although the facial nerve can be injured with some aggressive SMAS techniques, avoiding the nerve is quite easy when the anatomy is known well. This is especially true for MACS type facelifts since the nerve is quite deep near the ear, there is minimal dissection peripherally and no dissection under the SMAS where the nerve lives. Trust a board certified plastic surgeon who specializes in facial rejuvenation. 

Robert T. Buchanan, MD
Highlands Plastic Surgeon

Necklift procedure

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
A facelift with a necklift procedure would be your best option. Nerve damage is very rare. Normally after this surgery the skin is numb, but feeling quickly returns. Since the surgery is lateral to the three main trigeminal nerve banches, they should be safe.

A face and neck lift is what would help you the most.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I understand your concerns about nerve injury for any type of operation on the face. It's a risk that well trained plastic surgeons take very seriously.  

I think the problem you had from your chin implant was poor surgical judgment and technique. So, I would advise you to get evaluated by a board certified plastic surgeon, like myself, who will give you an honest opinion about benefits and risks to help you make the right choice. Not every cosmetic surgeon is a board certified plastic surgeon. Good luck!

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.