Rejected for a neck lift! Surgeon said my mylohyoid are sagging, advice? (photos)

Your question helps bring up an excellent point. Every patient has a unique anatomy and aging pattern. The results achieved in one patient will not be the same result in another patient. However, both patients will most likely be equally as happy as long as their expectations are in line with what can be achieved surgically.  I find that patients that I treat want to look like the way they used to or as close to that as possible. They have a vision of themselves from years ago that they no longer see when they look at themselves in photos or in the mirror. The surgeon who you saw probably had your best interest at heart.  Based on your consultation, it's possible that he or she didn't feel that they could deliver the results that you wanted. It's absolutely important to be honest during your consultation regarding the results that you hope to achieve. It is possible that the results you hope to achieve are not realistically possible. At your next consultation, bring photos of yourself in different angles from years ago, even high school. Your surgeon should be able to explain your aging pattern and show you photos of patients with similar anatomy to explain what can be realistically achieved, especially if they have dedicated their practice to facial cosmetic surgery.

Thanks for sharing your story and disappointment.  Based on your photos, it is probably true that you have a forward leaning windpipe (trachea) and a low hanging hyoid bone (with floor of mouth muscles such as the mylohyoid as mentioned).  This does not necessarily mean that you cannot have improvement in your neck, profile, and jawline...it just means you probably cannot achieve a 90-degree angle under your chin (which you probably never had in your lifetime anyhow).  So long as you and your surgeon agree as to what an expected result should be, then it should be fine to proceed with the procedure.  Your expected result would probably be on the more modest side, but if that is ok with you, then you should consider.

Thank you for your question. I suggest that you move forward and consult with a board certified facial plastic surgeon to determine your candidacy for surgical and non-surgical procedures that can achieve your desired result.
Best wishes,

Hello and thank you for your question. Based on your photograph, you may
benefit from a neck lift.  If good technique is used,
this can be done with minimal scarring and can result in a natural look, not
over-done look, with tightening of your neck.  Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results. The most important aspect
is to find a surgeon you are comfortable with. I recommend that you seek
consultation with a qualified board-certified plastic surgeon who can evaluate
you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

You have very typical early facial laxity issues with jowls and nasolabial folds. You can benefit from a facelift done by an experienced plastic surgeon who has a good portion of his practice dedicated to facial surgery. I have no idea why they have turned you down. There must be other reasons for it than your anatomy. Seeing you in person will answer this question. 

 If the mylohyoid muscle is hypertrophied, this can be  reduced  during the face and neck lift procedure. From the photographs presented, it appears that there is  fatty deposits in the neck which are usually located above and below platysma muscle. A platysma plasty is also required to rejuvenate the neck. a facelift procedure can also address tightening loose facial and neck skin as well as tightening loose facial neck muscles. For many examples of lower face and neck lifts addressing all these issues, please see the link and the video below

Based on your photos, you seem to have the typical problems in the lower face and neck that would benefit from a face and neck lift.  I think you should seek another opinion by a board certified plastic surgeon, who will be able to examine you directly and give you an honest opinion.  Good luck!

From your pictures it seems that you are a decent candidate for surgery. Sometimes a good physical exam can change this though. You might try a board certified facial plastic or plastic surgeon that specializes in face and neck for one more consult. 

 Hi, as a board certified facial plastic surgeon I have performed many facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  From the photos your one cheek is quite flat in the front, there is some excess fat that has sagged off of the cheeks towards the nose, jowls are present, I suspect that the chin is weak (can be confirmed with a profile photo in a relaxed position....see examples in the attached video) and there is some excess fat and skin under the chin.  These factors combine to create a rectangular shaped face.  Based on this, you are a candidate for a facelift and neck lift however the degree of excess skin in the neck may not warrant the more invasive "formal" neck lift.  This might explain the other opinions that you received.  This however, "does not" mean that something can not be done as described below.  Additional consultation with experienced facelift surgeons may be considered so that you can further explore your options.
  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  For cheeks that are concave or flat in the front, cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 Should the chin be weak, this creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.  Along with the minimally, invasive SMAS facelift described above, some of the excess skin below the chin can be removed using a small, curved incision under the chin.  This along with skin removed in front and behind the ear will tend to reduce the skin excess by around 70% or more.
 If anterior platysmal bands are present or the maximal amount of neck skin is to be removed, a "formal" neck lift can be done.  In this procedure, the face and neck tissues are elevated using a curved incision around the front (explained later) of the ear that continues in the crease behind the ear and then 3 inches into the posterior hairline.  The tissue is dissected from that point all the way across the entire neck to the same position on the other side of the head in a dissection that is as long vertically as the entire neck.  The Platysma muscles are tightened using a curved incision under the chin and each side is pulled upward and back again being tightened at a line behind each ear (under the tissues).  Since the skin flap pull is up and back, this will pick up any tissue laxity along the jaw line or "jowls" which must be dissected and flattened out using a lower facelift (incision around the front of the ears).  If this isn't done, pleats of excess skin will appear below each ear.
 This is an extensive surgery taking 4 1/2 to 5 hours with large incisions, requires placement of drains, possible hair loss and months of recovery.Hope this helps.