Want to address sagging/loose neck skin: why such a difference in advice from consultations? (photo)

Thank you for the question. Based on your photos you need a face and neck lift, in order to pull/rejuvenate the neck, lower face and mid face. I personally prefer adding fat at the time of the facelift as adequate amount typical stays, which is natural and permanent. All filler products are foreign to the body. I wish you the best of luck. Vasileios Vasilakis, MD. Double board-certified, fellowship-trained plastic surgeon, Houston. TX.

Hi, If you ask 10 surgeons/cosmetic doctors, you will likely get 10 different opinions. Both have good points, but I worry that those options will still not meet your expectation. In my experience improving the loose neck skin with a lower facelift alone has not been successful in my hands. I tried going tighter, and tighter on the facelift portion, but it never seemed to fully address the sagging of the neck. When I added the corset platysmaplasty to my surgical options to go along with the lower facelift, did my patients get predictable results. The corset platysmaplasty is the foundation for a necklift. A necklift lifts the neck. A facelift lifts the lower face and cheeks to some degree. A browlift lifts the brow. If I told you a browlift would improve the neck you might have your doubts (it won’t affect the neck), but when showing a patient how a facelift might appear in a mirror during a consultation, you will see some improvement in the neck. However, look even more closely to how much improvement you actually get with the facelift. If you are in the bathroom, try to catch a glimpse of your profile view. Then try pushing the skin under your “sideburn” hair in an upwards and backwards direction. You will like that it improves the lower face, jawline and marionette lines. However, you will note that the smile lines or nasolabial folds are not eliminated. Note that the neck waddle may improve 20-40%, but still be hanging in the center. Just operating on the sides of the face without actually performing a necklift, is the same effect as what you can do in the mirror by lifting your face. However, the real result will be less than what you can show with your fingers. I will have the patient lift up their face to their satisfaction, then relax their fingers down 50% and explain that when everything is fully healed and settled, that will likely be the final result. When performing the facelift, we may actually lift and tighten the tissues and remove skin to get the lift that you desire, but as the swelling comes down and the skin relaxes a bit over the first 6 months the results are more subtle. Even if you pull/lift your face super hard you will note that the nasolabial folds are still not gone. For this reason, both surgeons were still recommending some kind of injectable volume in the form of fat transfer/grafting or injectable fillers. Sorry the answer is getting so long, so I’ll just stop here. I hope you got some value out of this answer. Keep doing your research. Realself is a good resource for both doctor’s opinions, but also look at the Realself reviews from verified patients in your area, as well as the “Worth It vs. Not Worth It” for certain procedures to gain a more realistic expectation of these procedures which is independent of what the surgeon’s pitch. If you have a good rapport with the surgeon as well as like the before and after photos (which should be at least 6-12 month results, immediate results do not show how much it relaxes over time.) Best, Dr. Yang