Seeking aggressive revision. Neck tended to form adhesions over time and a wrinkled appearance after 1st neck lift (Photo)

Question

What could be done to tighten and create a smoother neckline?

J. Timothy Katzen, MD, FACS · Answer

Thank you for reaching out with your concerns about the need for an aggressive revision of your neck, particularly due to the formation of adhesions and a wrinkled appearance after your initial neck lift. Your history and the provided pictures have been very informative.
The optimal approach for your situation is a revision neck lift coupled with a corset platysmaplasty. The platysma, the vertical band visible in your neck pictures, is a key area of focus. The procedure involves an incision starting in front of the ear, curving around the bottom of the ear, and extending behind it. This incision allows comprehensive access to the lower two-thirds of the face and the entire neck.
A further small incision is made in the chin to expose the platysma. The key step involves reapproximating the platysma to the midline using permanent sutures, aiming to achieve a well-defined 90° neckline. Following this, the neck skin is meticulously redraped, suspended, and tightened to address your concerns effectively.
I understand your apprehensions, especially considering the adhesions and wrinkling that developed after your first neck lift. However, a revision neck lift with platysmaplasty is a robust and aggressive revision that should effectively remedy these issues.
I hope this answers your questions regarding the correction of vertical bands and crepey skin on your neck following a previous neck lift.
Sincerely,
Dr. Katzen

Richard G. Schwartz, MD · Answer

Your photos indicate a slender neck with minimal fat between the skin and underlying platysma muscle.  Therefore, there will always be a tendency for the muscle fibers to become visible.  You seem to have a prominent platysma muscle band, without any fat to camouflage it.  I suggest a secondary necklift to include wide skin redraping posteriorly to tighten the skin, Partial cutting and removal of a small triangle of platysma muscle and suturing of the 2 platysma muscle borders together and upward.  This should create a firmer, smoother neck contour and angle.

Gianfranco Frojo, MD · Answer

I believe that a revision neck procedure would be ideal to address the loose skin and loose platysma muscle band underneath). I would recommend finding a plastic surgeon with at least 6-7 years of training in actual plastic surgery.

Gregory S. Keller, MD, FACS · Answer

Sorry to hear about your problem.  Stretch back of the skin and muscle can occur if the skin is not young and elastic.  A secondary procedure is usually performed by the surgeon, should this occur, without a professional fee.  Neck lift revisions happen in the best of hands, despite the comments from others, and I have seen the necessity of these from world famous neck surgeons.  Often these may be performed under local.  Picture the neck as a trampoline that has been bounced on and loosened in all directions.  It may be best to tighten the platysma muscle and skin from all directions if it is loose: from above with a facelift, together with a corset, and backward with a neck skin excision.

Lane Smith, MD · Answer

You could definitely benefit from a Revision Neck lift. I recommend seeking out a Board Certified Plastic Surgeon to help you resolve your issues. If you would like to be seen by my office, feel free to reach out for a consultation. Smith Plastic Surgery 702-838-2455

Zoran Potparic, MD · Answer

There is no doubt that you need a new neck lift. However, considering skin laxity you may also consider a lower face/neck lift; fat grafting underneath thin neck skin may help to prevent the formation of wrinkles. In-person or teleconference consultation with a board-certified plastic surgeon, an expert in face/neck lifts, should be considered.

Steve Laverson, MD, FACS · Answer

Sorry to see your result, which shows residual loose skin and platysmal bands, both of which should be gone permanently (or for decades) after neck lift.  In answer to your question, "What can be done?", my approach would be traditional neck lift with sub-platysma surgery, corset platysmaplasty, sub-total infra-hyoid platysma transection, and other measures for the smooth youthful neck appearance that motivates and justifies the procedure.

Jacob Tower, MD · Answer

Hello, hope you are well. Your photos demonstrate two primary problems: skin redundancy and platysmal banding. Correct these problems requires three incisions: around and behind each ear to remove excess skin, and under the chin to eliminate the platysmal banding. 
Best,Dr. Tower

Michael S. Kluska, DO · Answer

What you are seeing is the edge of the platysma muscle. This can be treated with surgical procedures that help tighten and or partially remove the muscle. Wrinkling is primarily due to aging and sun damage and can be improved with skin heating devices such as Renuvion. If you would like to schedule a virtual consultation to further discuss, please get back to me vis your RealSelf portal.

William Portuese, MD · Answer

More information is needed Other than that what was presented. Please submit a full set of facial and neck photographs. Your next surgeon is also going to require a copy of the operative report to find out what was accomplished in the first procedure. It's important to know whether or not you've had a platysma-plasty long with myotomy performed in the first procedure.  You can try Botox injections into the one platysmal cord present prior to any revision surgery.

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