I am 38, thin and fit. I had smartlipo performed on my neck two years ago to tighten hanging skin under my chin. too much fat was removed and I had a necklift a year later to tighten the excess skin and tighten the platsymal muscle. One year later, I am left with crepey skin and sever irregularities under my chin (indentations and sagging on the lift side) It does not look natural AT ALL. My PS will do a skin lift only but I don't think this will help. Please advise.
Necklift Revision Advice?
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Doctor Answers 4
Another Smartlipo Problem
The major problem that seems to plague surgeons who insist on attempting to tighten neck skin with the Smartlipo laser is that the neck skin can be deceptively fragile and fat all to easy to remove creating a skeletonized neck which shows any and all contour problems beneath the skin. There are very few ways to reconstruct the damaged skin. I, and others, have found that adding fat grafts to the neck has tended to improve the contour problems and has had a secondary beneficial effect on the skin probably due to growth factors and cytokines stimulated by the fat itself.
To correct an aging neck, you have to approach this with a facelift. A facelift, which includes your neck is the only surgery to correct the problem you described. There is no such surgery as a "neck lift." Before you spend any additional time and money, consult with a Board Certified Plastic Surgeon, certified by the American Society of Plastic Surgeons (ASPS) to discuss your expectations and concerns.,
NeckLift Revision Advice
The idea of doing isolated Platysmalplasties for liposuction induced neck laxity is not something I have seen work too frequently. I have personally performed over 300 revision facelifts of other's work, and I have encountered this issue at least 4-5 times in my recollection. Here are the questions I ask and the approaches I take:
1. Can the skin laxity be addressed with some of the new skin tightening technologies? The reality is that the new RF systems on the market and ultrasound based systems like Ulthera can do alot of tightening compared to previous generation technologies. These systems can tighten some skin and re-establish a nice neck countour. Given the minimally invasive nature of these technologies, they are worth trying first if the practice is properly vertically integrated and has access to several of these systems.
2. Can the skin laxity be addressed with more laser Lipo? The reality is that laser lipo done in sequence can help tighten skin and reduce scar banding. In revision cases, I am particular to use only 1064 (smartlipo) frequency at 40 W, 12 Hz up to 2000 joules. With experience, the laser lipo can address alot of irregularities in this region without again a need for a more minimally invasive procedure.
3. Is the patient in need of a facelift, as nothing else will work? Unfortunately, the majority of patients I have seen with this problem fall into this category. Here, I like to perform a High SMAS, deep plane, short incision lift integrated with laser lipolysis. I redo the platysmalplasty and tunnel my lateral flaps through to the midline. The big difference in my experience to date on performing revision facelifts is that the Quill suture both medially and laterally will provide a much better tissue hold, and less recidivism of the area of concern (the mid-lateral neck) over time.
I hope you get this issue addressed.
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From what you describe, you might best be suited with a more limited procedure to correct the crepy skin under the neck. This can sometimes occur from a facelift with or without a neck lift component. There are several techniques available and often easy approach I use with my patients is undermining the neck skin through an extended submental incision which allows direct access to the loose neck skin and residual muscle bands. I would advise seeing an expert in facial plastic surgery certified by the American Board of Facial Plastic and Reconstructive Surgery to better address those concerns.
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.