33 yo neck lift and revision failed - seeking guidance (Photo)

This is a cobra neck deformity. This is related to excessive removal of the deep fat in between the platysma muscle bellies in the midline of the neck. It does not appear that the submandibular glands were reduced. It also appears that the platysma muscle has separated and there is now a gap out of the midline. I would recommend a deep plane neck lift to reduce the deeper fat further, sculpt the submandibular glands, repair the platysmal muscle bellies back together and very carefully perform superficial fat liposuction. The superficial liposuction of the fat immediately below the skin needs to be very conservative as this fat is critical to having smooth, shiny and normal looking skin. You need to find an American Board of Plastic Surgery certified surgeon; ideally, this surgeon has also completed an aesthetic fellowship accredited by the Aesthetic Society.

Thank you for your question and sharing your photographs.

The last image submitted suggests that there is excess volume from the digastric muscles and possibly also from the submandibular glands. In general, one has to assume that the degree of lateral tensioning your surgeon has achieved so far has delivered as much as lateral tensioning can provide.

To improve the results further, it is likely necessary to repeat the access under the chin and perform additional reduction of the volume from the digastric muscles and submandibular glands.

If you would like to determine more precisely what is contributing to the volume excess under the chin, one option is to have a sitting MRI. This imaging will highlight exactly what is going on and identify the specific tissues producing the excess volume, which can then guide the next steps for treatment.

Much more information is needed, such as a full set of facial and neck photographs and a copy of the operative reports to find out what was accomplished in the first and second procedure. From the one limited photograph currently, it appears that you have a combination of prominent submaxillary glands, prominent digastric muscles, and a separation of your platysma muscle sutures.