What is the Best Revision /correction for Treating a Cobra Neck Deformity?

I had a lower facelift that included smart lipo under chin and playtsmal tightening 7 months ago. I now believe I have a cobra deformity based on significant research. My ps gave me a thermage treatment 2 months ago with minimal/ no improvement. I will be seeing my ps next week. I have read that correcting this deformity s very challenging. Some suggest a reverse facelift and others suggest fat grafting to fill in the hollows. I am in good health, a good weight, do not smoke. I am 57 years old.

Doctor Answers 9

What is the Best Revision /correction for Treating a Cobra Neck Deformity?

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What is the Best Revision /correction for Treating a Cobra Neck Deformity?  The excess on either side of the hollow would most likely require a formal neck Lift the remove excess fat and tighten the platysma muscles.

Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Cobra neck deformity

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This is a difficult problem but can be improved by all the techniques you mentioned.  I have used fat grafting with some success as well as undermining and advancement of the medial platysmal borders

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 231 reviews

Cobra neck may need a neck lift revision to treat or fat injections

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This can be corrected so don't worry. A neck lift revision may be the answer for you. Sometimes the neck lifts that are performed by other entail removing the fat under the chin area and then an incomplete neck tightening. That is the most common cause for the cobra deformity. You will need more neck muscle tightening in my opion based on the limited information to improve your situation.

Philip Young, MD
Bellevue Facial Plastic Surgeon

Correcting cobra neck deformity

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The cobra neck deformity is created by too much fat removal at the central portion of the neck and a separation of the anterior platysmal bands.  The bands then hang down laterally with a central fat hollowness.  This is best treated through a revision neck lift whereby the anterior platysmal bands are further sutured together in the midline.  Fat grafting can be used, however, is usually not necessary.  It is also important to make sure that the lateral subplatysmal fat has been removed.  The anterior platysmal bands are transected at the level down lower in the neck, which lengthens the muscle and the anterior platysmal bands usually disappear.  This is the best treatment for the cobra neck deformity.  Make sure that a surgeon who is very experienced in this area performs this.  

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Surgical revision is likely needed, Fat grafting not so great for this area

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I agree that the majority of "cobra neck" deformities occur due to these reasons:

1. Excess removal of midline fat or insufficient removal of lateral fat (too much fat taken from the area under the chin or not enough fat taken from area under jawline)

2. Insufficient plication of the platysma muscle (the platysma muscle is a thin muscle that causes the bands seen in a turkey neck or after lipo is done. The edges of the muscle need to be properly brought together and secured in order to provide a smooth contour to the neck)

3. Fat grafting when done properly is an excellent technique for filling in contour deformities. However it's effectiveness is diminished when trying to correct deformities after a necklift due to the scarring and "reduced" blood supply that occurs after a necklift. It simply is not a very welcoming area for new fat cells to be transplanted!

Take care and good luck!

Kamran Jafri, MD
New York Facial Plastic Surgeon

Revision neck lift for cobra deformity.

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I would need to examine your neck to give you a valid answer as there are several choices which are available depending on what has been removed from your neck and what remains. For more than 30 years of treating these problems I have seen many different causes. See an experienced facelift surgeon.

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Correction of the Cobra Neck

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This deformity classically presents with hollowness under the chin and remaining fullness to either side. My treatment varies by the particular situation but usually relies on fat grafting to the area of hollowness. In addition, redundant fat on the sides plus lifting of remaining loose platysma bands provides a good balancing of the neck with a smoother contour.

Frank P. Fechner, MD
Worcester Facial Plastic Surgeon
4.6 out of 5 stars 48 reviews

Correcting a Cobra Neck Deformity

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You are correct in that it is a challenge to correct this problem. Sometimes a direct skin excision and w-plasty may be appropriate. Fat grafting in my opinion rarely works as the fat rarely survives in that area. Thermage, contoura, etc. ultrasound, I think have limited utility as well. Depending upon the extent of the deformity, sometimes filler might work and sculptra might be an option. Advancing the soft tissues of the lateral neck upward as in a 'reverse lift" can also be done. I would discuss these options with your surgeon or seek another opinion.

Scott Trimas, MD
Jacksonville Facial Plastic Surgeon
5.0 out of 5 stars 20 reviews

Best Revision /Correction for Treating a Cobra Neck Deformity

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I am sorry to read of your disappointment. It would be helpful to know more about the surgical techniques applied during the procedures as you may benefit from additional surgery to better correct your concern. Nevertheless, it's best to wait at least 6 to 12 months depending on the reason for a #revision.

It would be best to consult with a board-certified surgeon in-person as you may have more than one option. The presence of banding down the front of the #neck, and, amount of excess skin and condition of your skin are among some factors which determine if you are a #candidate for #rejuvenating the neck. Chin deficiency with the neck and jawline are also taken into consideration. A weak #chin implies a lack of chin support for the skin along the neck line. As a stand-alone procedure, chin augmentation can be performed in the office under local #anesthesia. For individuals with signs of aging in the neck, a chin implant added to one of the recommended procedures above, will provide optimal results.

Also, your procedure should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery and #neck lifts. Additionally, you should feel confident and comfortable with the doctor you choose. Whether it is the same doctor who did your original surgery, or, you feel it necessary to seek a new one. 
As with all #cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical #procedure and #revision, there are some risks of unhappy outcome or other complications which your surgeon should discuss with you during your consultation. You will then greatly improve your chances of getting the result you desire, and, without the need for additional revision surgery.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 116 reviews

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.