After Parotidectomy - What's Best Option to Address Jowls/saggy Neck? (photo)

Question

I would like to have a facelift and a neck lift to address jowls and loose skin on my neck. I had a parotidectomy ten years ago. After researching this site, I understand that many surgeons do not recommend having a facelift after a parotidectomy due to the increased risk of facial nerve injury. What would be the best course of action to address my jowls and neck? Would a neck lift be advisable?

Babak Azizzadeh, MD, FACS · Answer

Yes, there is increased risk after parotidectomy. You would need a facial nerve and facelift expert to perform the facelift. An expert could also correct indentation at same time if present.

Boris M. Ackerman, MD · Answer

Facelift after Parotidectomy is somewhat risky as the facial nerve can be more easily injured during the surgery. I routinely perform facelift on the patients that have had partotidectomy. An operation report from the Parotidectomy might be helpful to assess the residual anatomy. Whether or not operation report is available, a thorough pre-operative examination of facial tissues will guide my surgical approach. Of course, special considerations and techniques need to be utilized. In most cases a dramatic correction of cheeks, jowls and neck is possible despite partotidectomy.

James M. Ridgway, MD, FACS · Answer

Hello,

	You ask an excellent question. You can have a facelift (which treats the face and neck) as well as a dermal-fat graft to fill any defect from your parotid surgery. It is important that you entrust your care to a specialist in this area and one who is also experienced in facial reanimation as these skills sets help to ensure quality results and function.

	Be healthy and be well,

	James M. Ridgway, MD, FACS

Mark Anton, MD, FACS · Answer

Hello Dljinok- You appear to be a great candidate for a facelift procedure. Although the facial nerve anatomy can be altered with a prior parotidectomy, a facelift can still be safely performed. There are methods of dissection which allow one to detect the location of a facial nerve before physically encountering it. Though nothing substitutes for knowing anatomy exceptionally well. Ask your surgeon how he/she did in anatomy in medical school :). Find an American Board Certified Plastic Surgeon, preferably having completed a Facial Surgery Fellowship, who has postop facelift photos that look natural and that you like.

Be safe.

Be safe.

Vincent N. Zubowicz, MD · Answer

Facelift can certainly be done after parotid ectomy. Very rarely can it even can be done concurrently provided the path of the parotid tumor is known to be benign. Inexperienced surgeon will will be able to negotiate the facial nerve without damaging it.

Giancarlo Zuliani, MD · Answer

I have encountered this similar situation in practice and it is always best to discuss all the possible risks with the patient. An important factor is that you seek a surgeon well versed in different types of facelifts and one that has a very keen understanding of facial nerve antomy and the parotidectomy operation as well. If you have a sunken appearance then I would suggest fat transfer as well. Your old operative reports are very important to review as well since many times alloderm, or a flap from neck muscles or the SMAS (name of tissues tightened in facelifts) will be transposed to help cover the defect. This is critical to know. Your surgeon would also want to know if your parotidectomy was done for a benign lesion or a cancer as you may have received radiotherapy. Flaps should not be elevated in a radiated field during an elective procedure as this increases your liklihood of skin necrosis.

	With all that being said, a thick flap facelift or vertical minimal incision facelift can be performed quite safely with minimal anesthesia.Best to you!

Jeffrey B. Wise, MD, FACS · Answer

In my practice, I rarely perform a standard facelift if a patient has undergone parotidectomy surgery in the past.  If undertaken, I would modify the technique to minimize the risk to the facial nerve.  There are a number of less risky or non-surgical options they are worth exploring.  If possible, I would recommend performing this procedure with nerve monitoring (a device that lets the surgeon know if he/she is near the facial nerve during a procedure).

	--Dr. Jeffrey B. Wise, MD, FACS

Nima Shemirani, MD · Answer

Dear dijinok,

	
		It would be best to see multiple views of your neck to see what can be done
	
		You can do a non-surgical jowl lift using microliposuction that can be done in the office
	
		A necklift would be safer than a facelift and this can be an option if it would meet your expectations
	
		I would visit a facelift expert since your anatomy has changed from the parotidectomy for an opinion


	Best regards,

	Nima Shemirani

Ashley B. Robey, MD · Answer

After a superficial parotidectomy, it is likely that your facial nerve is sitting just under a layer of skin and subcutaneous fat. This more superficial location of your facial nerve would put you at increased risk for facial nerve injury for any kind of face lift or neck lift. Injury to the facial nerve can result in temporary or permanent facial paralysis. That being said, if you and your surgeon felt comfortable with those increased risks, it is something that could be considered. 

	Other options might include something like laser resurfacing which could help tighten and rejuvenate the appearance of your skin.

Kamran Jafri, MD · Answer

Having a facelift after a parotidectomy certainly puts the facial nerve (which moves the muscles in your face) at greater risk than if you did not have a parotidectomy. This fact however does not mean that you cannot safely undergo a facelift procedure with the understanding that you are at greater risk than other patients. End of the day, if you have absolutely zero desire for any possibility of injury to the facial nerve then best to not have a facelift. You could opt for a mini-lift or minimal incision facelift that avoids the areas where your parotid gland used to be. You would certainly see some nice results albeit not as significant as a modified facelift.

	You are concerned about sagging jowls and loose skin on your neck and by looking at the picture provided (naturally more pictures and an exam would be helpful) you have mild to moderate aging changes. Safe to presume you have had a superficial parotidectomy on the right side. Therefore a modified facelift procedure with some volume replacement on the right side would be a nice procedure for rejuvenating your areas of concern. I cannot see your neck very well in the picture but looks to be minimal skin sagging so I do not think an isolated neck lift would be needed.  A facelift extended down towards the neck would elevate the neck area sufficiently.

	A surgeon experienced in both parotidectomy surgery and facelift surgery would be helpful in this case. The key is to preserve the facial nerve from any injury while maximizing the results a facelift would give you. In addition Alloderm or fat transfer could be used to provide a little more volume to the right side so both sides are more even after they have been lifted up.

	All the best,

	Dr. J