Neck Still Turkey-like After Lower Facelift and Necklift with Platysmaplasty? (photo)

Question

I had a mini facelift and necklift with platysmaplasty 4 months ago with incisions in front and behind ears and under the chin. Pictures attached. The face is much better than it was, but the neck has dropped back to where it was, a very large band is even more prominent, and the scars are bad on one ear only. I've already tried Botox, and it did nothing. Any idea what went wrong? Also, is there a procedure to cut out that errant band all together, or tie it up somehow? I'm 57.

Kenneth Hughes, MD · Answer

If there was a lot of redundant skin, muscle, or fat, there is always a chance of recurrent skin under the chin, no matter what was done. Your anatomy may be amenable to a small neck skin and/or muscle tightening procedure through an incision under your chin. It is difficult to tell if the band is a true platysmal band, skin, or both. They would all have different treatments but could be addressed with a revision neck lift. Kenneth Hughes, MD Los Angeles, CA

Jed H. Horowitz, MD, FACS · Answer

I am sorry to read of your disappointment. It would be helpful to know more about the surgical techniques applied during the procedures as you may benefit from additional surgery to better correct your concern. Usually, it's best to wait at least 6 to 12 months depending on the reason for a #revision.  Also, your procedure should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in the types of cosmetic procedures you have endured. Additionally, you should feel confident and comfortable with the doctor you choose. Whether it is the same doctor who did your original surgery, or, you feel it necessary to seek a new one. As with all #cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical #procedure and #revision, there are some risks of unhappy outcome or other complications which your surgeon should discuss with you during your consultation. You will then greatly improve your chances of getting the result you desire, and, without the need for additional revision surgery.

David Hansen, MD · Answer

From the photos, you really need a total re-do face/neck lift. The scars can be improved and the pixie ear fixed as well as getting a better neck lift. Fortunately, this can all be done under local anesthesia with less downtime, bruising and swelling than under general.  Sometimes when the doc rushes and tries to do a lot of work in a couple of hrs, the results show it. Expect at least 5 hrs to get the best results and it will be worth it.  Sincerely,

	David Hansen,MD

Stephen Weber MD, FACS · Answer

Unfortunately, the neck is usually the first place that a mini-lift will fail. As my colleagues have noted a traditional face and necklift would be required to improve the platysma bands that have recurred. This is the only procedure that allows a robust tightening and repositioning of the neck tissue. There is a procedure referred to as a submentoplasty that can directly remove the lax neck tissue. I will only perform this a handful of times each year as a facelift is superior and more comprehensive. The submentoplasty can be performed in numerous ways and each method seeks to avoid an objectionable scar. However, despite all of these various techniques, the submentoplasty will usually leave a visible midline scar that can take up to a year to heal. I hope this advice is helpful.Stephen Weber MD, FACS

Eleanor J. Barone, MD · Answer

To get rid of. This means more incision, more swelling and bruising for some patients, and more work. Basically the bands must not only be sewn together (plication), but to be extra sure, the also should be divided or cut just above the the first hard cartilage you can feel in the middle of the neck. The skin of your neck has to be completely lifted off of all these tissues, again until about the hard bump you feel in the middle of your neck. Then I recommend a garment around the head and neck afterwards to help the skin 'stick' back down. Your tissues won't be completely healed until at least six months after the original surgery. Then you and your board certified plastic surgeon can discuss what can and cannot, should or should not, be done for any remaining issues.

Michael R. Menachof, MD · Answer

Your photos show one of the problems with a short scar mini facelift. In this kind of a mini facelift three things happen that allow for a less than perfect result in the neck (even if you have a platysmaplasty with it). First, in this type of lift both the face and neck have to be pulled in the same direction (in actuality, the face needs to be pulled upwards while the neck needs to be pulled in a more lateral direction). In order to get the face to look good you pull mostly upwards, sacrificing the results in the neck. Secondly, the skin of the neck needs to be elevated all the way across in order to get a nice, smooth result. In this kind of a lift you usually don't open the neck all of the way across (would not be mini if you did that). Third, the incision behind the ear in a mini lift is not long enough to allow for the lateral pull of the neck skin that is needed to get a smooth result in the neck. As with everything we do in facial plastic surgery, this is all about expectations. Looking at the preoperative appearance, your surgeon should have been able to tell you what he or she would be able to accomplish with a mini facelift as compared to a more traditional facelift. It is likely that even though the result you got was probably a good one overall (and it was nice to have a shorter surgery and recovery time), the result you got in your neck was also probably the likely outcome with this "lesser" procedure. Unfortunately, in order to correct this you will need to have a more traditional neck lift done incorporating the points I mentioned above. Best of luck.

Samir Shureih, MD · Answer

It seems that you had a short scar facelift. The incision behind the ear does not go to the hair line and that did not pull on the nck skin.

	You will need a nieck lift to get rid of the overhang of skin under your chin

Richard P. Rand, MD, FACS (retired) · Answer

Unfortunately, you will need to have an extensive redo to remove the excess skin that is still in your neck. A Mini facelift and short scar techniques are more prone to leave behind these excesses. A direct excision in the midline of the neck will leave you with a potentially unsightly scar.

Oleh Slupchynskyj, MD, FACS (retired) · Answer

Hi,

	It looks like you have excess skin left from your facelift. This sub-mental skin is usually removed during a facelift procedure. Extensive undermining of the sub-mental skin needs to be done to remove this excess.

	Best,

	Dr.S.

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