Facelift revisions/touch-ups: how do surgeons decide if they will do this, or when the patient is being unrealistic or neurotic?

I feel that the platysma bands are showing (more than pre-surgery) & that there is still some loose skin under chin (I had corset platysmaplasty & full FL/NL 7 months ago). Many surgeons on realself seem to say that this is a relatively common result, and that a "touch-up" procedure will correct it. However, I am worried that my board-certified surgeon thinks I am being neurotic (I am rational & polite) and will refuse to do the corrective procedure. Under what circumstances would he refuse?

Doctor Answers 5

Platysmal bands and loose skin

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Both of the above problems can be difficult areas to obtain a very consistent result or improvement.  I think the only real reason most surgeons will refuse is if they believe the revision or "touch up" will not correct the problem or will make only a minimal improvement that is not worth the risk of a revision.  If there is little fat covering the platysma muscle, even mild banding may be visible and hard to treat.  If the platysma was not divided along the cord with the first operation then doing this with a revision would likely make a significant improvement.  Speaking with your surgery about all these factors would be the best place to start.

San Francisco Plastic Surgeon

Facelifting #woundhealing #cosmeticsurgery #BOTOX #tmbcosmeticsurgery

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Dear Heartease

Thank you for posting another question!  You should follow up with your surgeon and review the goals of your surgery and if your concern about your results is fair.

With Warm Regards

Trevor M Born MD

Trevor M. Born, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 126 reviews

Platysmal bands after facelifting may require further work

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Platysmal bands are present after a full face and necklift if (a) liposuction is overdone,  (b) the active platysma is not addressed with partial denervation, or (c) the redraping of the platysma is inadequate.  You should return to your surgeon and ask for a honest & transparent evaluation of your results.  If the result is inadequate, you might consider a revision. When I evaluate patients with a story similar to yours, oftentimes, we consider a revision procedure that involves partial or complete backcuts of the platysma, complete removal of the inferior platysma (platysmectomy), and/or possible further posterior rotation and tightening of the platysma.  This can be a frustrating problem, and I have empathy for your situation.  Good luck to you!

Tanuj Nakra, MD, FACS
Austin Oculoplastic Surgeon

Facelift revisions/touch-ups: how do surgeons decide if they will do this, or when the patient is being unrealistic or neurotic?

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You have a thoughtful question. I would return to your original plastic surgeon and have an honest conversation with him. I think that he would appreciate that. If you are unhappy in any way, the only way to correct it is too voice your concerns. However, it may be a little early to consider revision. It depends on whether you have completed this healing process. There frequently are small things that can be done to fine-tune the result. I wish you the best.

Revisions and Neurosis

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Thank you for your question. Just from how you have phrased your question it sounds like you are thoughtful and generally happy but do have some minor residual concerns. I can only speak for myself so as a plastic surgeon I encourage patients to sit down with me to explain their concerns after the appropriate healing period has passed. We review their concerns together so that we can make a game plan. Not all residual things are fixable and the patient needs to understand that they may be improved but not gone. If they want to go ahead and have realistic expectations then we proceed together. Obviously, if their concerns can be completely resolved, which is unusual, then we simply move forward and take care of it. The difficult area is when patients have a result that the surgeon feels can't be corrected or is so minor that the risk outweighs the benefit. This can be a tougher issue to get on the same page. Finally, we occasionally come across a patient who is unhappy but truly does have a good result. This is a difficult situation to remedy since the surgeon is likely to decline further surgery.
I would recommend you sit down with your surgeon and discuss your concerns and how best they can be addressed. You chose this MD so you must have felt comfortable enough for you to have surgery with them. Im sure they will listen to you and try and help you achieve your goal
Best of Luck

Lee A. Gibstein, MD
Miami Plastic Surgeon

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.