Sagging, Rugged Neck Skin After Endotine Cheek and Neck Lift

My mother went for a Endotine Ribbon cheek and neck lift a month ago due to sagging skin. But her neck and cheeks are starting to sag again and she's worried. The ribbons are also very noticeable now, and she has rugged skin under her neck. Is there any chance that she will stay with those signs permanently?

Doctor Answers 14

Entotine facelifts are a waste of money.

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In my career, I have been witness to all sorts of foreign objects placed in the face to support an ersatz facelift.  They never work.  They are foreign bodies that get encapsulated and thus isolated from the surrounding tissue.  They don't make sense and they don't work.  A well executed facelift is safe and gives predictable good results using the patients own tissue.

Unfortunately, the result she has will probably get worse

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Whether they call them minilifts, week-end facelifts, wire lifts, etc. the end result is the same in patients who need a conventional facelift. Minilift = mini-result! You have to remove the extra skin and tighten the deeper tissue to get a good result. She can have a full facelift at about 9-12 months later.

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

Avoid any lift that has a brand name attached to it - they are gimmicks

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To Claudia RG,

Hi! In a few months your mom will - hopefully - look like nothing happened. Then she will have to consider a real facelift.

To look younger (rather than pulled), and to have the result last, you really have to REPOSITION the skin and the fat upward. You cannot just pull on the skin.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Some good news

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The endotines are absorbable. They can take a long time, but you can count on them going away.

The bigger issue is the early sagging. In most instances this indicates that a revision will be needed, as retrospectively, the tissue re-suspension was not adequately addressed. Fortunately, a secondary procedure is usually no problem, but it should be done after consideral healing time - 9 months to a year if possible.

It would be advisable to have a frank discussion with the surgeon on a modern face lift technique with a proven track record.

She might need a revision facelift or a minifacelift

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Unfortunately, there is no magic solution for sagging facial and neck skin yet. Sounds like your mother might need to have her skin tightened with a facelift or a mini facelift. I've had to do that in the past for patients who had strings, threads etc. placed trying to tighten their skin. Usually we had to remove the strings, but the ribbons should absorb after a while.

Have your mother wait for several months to see how her healing is going, and then consider additional tightening and possibly removal of the ribbons if it remains a problem. The good news is that it is a relatively easy procedure.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Ribbon lifts / Endotine

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I wish I could tell you that further sagging would not occur. However with suspension techniques, they tend to be short-lived, in my experience. Visible suture material also typically does not improve without treatment.

Fortunately, it is possible to perform revision surgery in the majority of patients and convert their surgeries to bidirectional facelifts / cheeklifts, and usually remove the ribbons / strings / Endotines in the process.

This usually accomplishes the goal of the rejuvenation the patient sought initially, without the large amount of foreign material, and with much more smooth, harmonious, permanent results.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

It sounds as though she didn't have the right procedure

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If she already has sagging skin in the neck, she really needed a true facelift done . Unfortunately, many patients hope they can get a great result with a lesser procedure and their doctors imply that they can, when the reality is that a minimal procedure isn't enough. Now she will likely have to endure the costs of additional surgery that wouldn't have been necessary had it been done properly in the first place.

Endotine device will dissolve, but it is not the gold standard for lifting.

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The Endotine appliance will eventually resorb since it is a dissolvable device. Unfortunately, most of the effect achieved with Endotine will be lost if the tissue was not surgically lifted, fixated and removed. This is the shortcoming of not only Endotine, but also the Thread Lift and other non-invasive types of procedures.

Peter Schmid, DO, FAACS
Longmont Facial Plastic Surgeon

There are no shorcuts

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Here is what I tell patients:

Small procedures get small results. To help a truly sagging neck a more involved procedure is usually required. This involves tighttening the platysma muscle in the middle of the neck and lifting it from behind. A simple pull from the side tends not to last.

Benjamin C. Marcus, MD
Madison Facial Plastic Surgeon
4.7 out of 5 stars 46 reviews

Recurrence of sag after endotine lift

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Some surgeons like to use endotine because it seems to be a less invasive approach which appeals to patients. Unfortunately there can be proeblems with this technique: recurrence, visibility of the endotine, irregularity of the lift, etc. Traditional necklifts are more enduring and predictable. The good news is that the endotine will disolve in time. As always preoperative consultation should give the patients the alterantives available and limitations and expectation of each approach.

Andrew Pichler, MD
Sacramento Facial Plastic Surgeon

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.