I had a face and neck lift 5 months ago. There is still laxity in the neck area which is concerning and disappointing. Is it true that sometimes a surgeon can only take up so much laxity the first time and that revisions are sometimes needed to achieve the desired results? What is the suggested time to wait? Thank you.
Are Revision Facelift and Neck Lift Surgeries Common?
Doctor Answers 32
Skin still lax after a facelift
A picture is worth a thousand words, so in absence of before/after pictures I'll do my best.
There is a delicate balance between too tight and not tight enough when performing a facelift.
- Not tight enough and there is some residual laxity and the patient may be unhappy
- Too tight and the patient looks scared and they are definitely unhappy
No surgeon can do with a knife what a patient can do with their hands... A patient can pull the skin up and it looks so easy and wonderful. In surgery, all the pull is at the margin of the ear and back of the neck... as you move more toward the midline, the pulling effect gets less and less... unfortunately, those are the areas that most patients are looking to improve.
Often there can be complimentary procedures to help tighten some of the residual areas, depending on the degree of laxity. A chemical peel or laser resurfacing are two reasonable options. Before considering revisional surgery, I prefer to give the skin up to a year to completely finish healing and show me its final result
The most frequent request for facelift revision for people who come to see me after a disappointing result from a facelift is too much fat being removed during facelift surgery. This can leave people looking too tight, hollowed and often older than they looked before a facelift. This kind of result can definitely be improved by structural fat grafting. I urge prospective patients to look at many before and after images as evidence of the expertise of the plastic surgeon they choose.
There are some cases when a facelift might require a revision, or a follow up. If a person has very, very poor skin quality due to years of smoking, sun exposure and / or significant weight loss, the integrity of the skin can be compromised. These are issues your plastic surgeon should discuss with a patient PRIOR to surgery, so a person with compromised skin will understand that there may be some laxity soon after surgery is performed. In these situations, the result of a facelift may look great soon after surgery but the ideal result may not last because of the poor condition of the skin. In these cases, patients may still be very happy with the improvement, but they might hope for a long term result like they experienced soon after surgery. In these cases, a revision surgery, much less involved than the initial surgery can be performed.
However, for most patients with good skin quality and normal aging, the result of a facelift should be lasting and very satisfying.
It is true that in some cases a patient will need a second facelift to get the optimal result. Going back to surgery and having things re-tightened is occasionally required but you should wait about a year before having this done.
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Revision Facelift Surgery
Unfortunately, every Facial Plastic Surgical procedure carries with it the possibility of revision. At the same time, revision surgery, especially for Facelift, should be relatively rare; a low revision rate (1-5%) is typical of an experienced Facelift Surgeon who take the time to understand an individual patient's concerns and expectations. The possibility of revision increases when a patient is overweight, or has a very heavy neck. The classic timing for revision is about a year, by can vary based on the circumstance. The best place to start is with a frank discussion about your concerns with the Surgeon who performed the procedure.
Revision Facelift and Neck Lift are not common, but sometimes necessary to remove excess neck skin
A revision of a Facelift and or Neck Lift is occaisionally necessary, but not usual.
The most common revision is the neck.
Sometimes the lax neck skin cannot be totally tightened even with an excellent Neck Lift and Platysmaplasty. In these cases a revision is necessary and usually involves a local procedure which includes excision and removal of excess neck skin with a visible external incsion on the neck beneath the chin.
If a good complete Facelift and Neck Lift have been done and lax skin persists on the neck, local excision is required. It is not done at the time of the original surgery in the hope that an external incision will not be required.
Facelift and Neck lift revisions
The second point is knowing exactly what technique was used for the neck lift since frequently the technique used dictates the final result.
Revison face lift
Sometimes a revision is necessary because there is residual laxity in the neck or cheeks. Probaqbly happens in less than 5%.
Revision surgery after facelift.
At five months you should be seeing an excellent result not thinking of a revision. Without a picture to see where you started it is hard to be specific about your degree of laxity. I would recommend you discuss this with the surgeon who did the surgery and see what he/she recommends. I normally do not re operate on face lifts for a full year to let everything settle down unless there was a clear mistake made and I feel it can be corrected. This shortens the time period the patient has to endure a bad result.