What neck lift surgical style would give me the best revision results?

Question

I am in process of interviewing surgeons to have a neck lift revision surgery. The first time around, i was still left with loose skin and a huge scar behind my left ear. My question is which neck procedure is the best? One surgeon told me that the incision should be placed at hairline and one surgeon said the incision should be in front of earlobe and up back of ear and hidden inside of hair. Which style would give me the best results??

Brian K. Machida, MD, FACS · Answer

On the left ear, it almost looks like a residual excess skin redundancy in the sulcus behind the ear.  There appears to be a slight stepoff in the your hairline indicating the incision was brought back into the scalp.  It looks like the incision was brought high at the origin of the helix, which might explain the redundancy in the sulcus.  I would recommend a necklift in the form of platysmaplasty, and incisions in front of the earlobe, up the sulcus and back down in the hairline but not into the scalp(to avoid increasing the stepoff in the hairline).  I would also recommend making the cross over incision between the postauricular sulcus and the hairline incision lower in order to change the vector pull on the skin flap and help that skin flatten out.  You should wait a minimum of six months before proceeding.

Phillip Chang, MD · Answer

Hi beano0709

The neck lift is performed after the neck liposuction and/or platysmaplasty if the patient needed one or both of those procedures. It is performed by making an incision beneath the earlobe that extends in upwards behind the ear in the crease between the ear and the skull. Once the incision reaches the top of the ear, it is extended posteriorly into the hairline creating a hockey-stick appearance. The excess skin, fat, and platysma are elevated and tightened.  To learn more about this procedure, please visit our website.

Jason Emer, MD · Answer

revision surgery require an expert and scars should be treated with lasers 3 weeks post suture removal and pretreated with vivatia foam, cosmelan 2, emerageskin aox c and refit face to promote better healing when you get treatment.

if you want a dramatic change necklift/facelift, Implants and fillers will give you that. noninvasive will improve the area and facetite, threads, morpheus, and fillers can be used.  start at home dermarolling to tighten you skin, we recommend 0.5mm MTS roller with anteageMD ampules daily (see dermarolling package).

With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles.  You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and lasers for texture
2. botox, disport or xeomin to help platysmal bands
3. intensif or fractora RF microneedling for crepe skin and lifting
4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening
7. ultherapy and thermage for external tightening
8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
see an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer

Scott Trimas, MD · Answer

The platysmal band that you have likely will need a platysmaplasty in order improve the central neck. If you still have loose neck skin then a revision of the skin portion of the neck lift can be done to revise the scar and bring it back into the sulcus of the ear where it is more hidden and directly into the hairline in order to avoid a step off. Typically if an incision is required in the front to improve your neck and or jaw line, then I prefer the incision to be behind the trigs to make the scar less visible.

Nelson Castillo, MD · Answer

Thank you for sharing your question and photographs. Unfortunately it is difficult to base recommendations on the photographs as one would need to feel your tissues in order to provide the best information on treatment of the skin excess versus muscle tightness.  The scarring also complicates matters for blood supply and because there does not appear to be a lot of excess/sagging tissues that can help remove a portion or all of that scarring.  Seek out a series of specialists for in-person discussions.

Kenneth Hughes, MD · Answer

I typically make only an incision hidden around the ear (periauricular incision). The incision does NOT extend into the forehead or into the hairline. Reviewing more photos would allow me to provide specific guidance.

Patrick Flaharty, MD FAACS · Answer

The best neck lift can be achieved with an incision behind the ear and along the edge of the posterior hair line. This would allow removal of your hypertrophic scars and the most powerful lift to the neck. We also like to add Face Tite to the anterior neck to further tighten this area. This involves delivering radiofrequency energy under the skin to contract collagen and improve the contour in the anterior neck. Face Tite can be delivered through a small needle puncture and does not require sutures.

William Portuese, MD · Answer

Much more information is needed, such as you age, and a full set of facial photographs from all angles in addition to a copy of the operative report to see what you had done in the past.  In our practice, a neck lift on the removed fat in the neck which includes a platysma plasty.  No skin removal is required.  A lower face and neck lift is required  when there is loose and inelastic skin in the face and neck.

Michael J. Yaremchuk, MD (license resigned) · Answer

It does look like you either have remaining loose skin of platysmal banding. The neck lift scar will go behind your ear in the sulcus and extend posteriorly either into the hairline or along the hairline. Sometimes, there is additional skin bulging around the ear lobe requiring an anterior extension of the incision in front of the ear lobe.

What neck lift surgical style would give me the best revision results?

Answers (9)

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