Sagging of the neck 11 months after SMAS facelift (includes the lateral face and jawline) (photo)

Also had mid face suspension.

11 months after SMAS facelift (includes the lateral face and jawline) . Also had mid face suspension. Terrible sagging under my neck after surgery. Is this normal sagging of the neck 11 months after SMAS facelift (includes the lateral face and jawline) . Also had mid face suspension. Total cost $13k. sagging very noticeable right in the middle under my chin. Also marionette crease getting deeper on right side of face which was not there prior to surgery. Jowling is also concerning. Is this normal?

Doctor Answers 10

Sagging neck after SMAS facelift

You appear to have loose skin and lax platysma muscles as well as residual jowels. Without a preoperative side photo I cannot completely assess, however a secondary lift or platysmaplasty is likely the only solution.

Sydney Plastic Surgeon
4.5 out of 5 stars 88 reviews

Neck issues after a facelift

I see many patients come to me for revision facelifts with results like yours. It is important to know if the neck started out great but sagged again (implying that your tissues aren't great) or if it never looked great (maybe a result of the technique used). If it never did look tight and angular, I'd imagine that you may have had only liposuction done there and not an "open" approach with muscle tightening. Discuss your feelings calmly with your surgeon and see what they recommend.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

Loose neck after face lift

Some patients do get residual rebound laxity, and need a revision or touch-up within a year.  It happens to the best surgeons too.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Evaluation of facelift results

To fairly evaluate and answer your questions I would nee a complete set of pre and post operative photos.   The end result of a lift depends largely on what you looked like to start.  This gives a real picture.  The best step is for you and your surgeon to sit down side by side and compare one by one a set of pre and post operative photos.   Every surgeon is willing to do this or should be at least.   This sit down conference should benefit you greatly.   A second little tuck may or may not be in order.  For touch up surgery,  generally the patient covers the anesthesia and operating facility and the surgeon does not issue a surgical fee.  My Best  Dr C

George Commons, MD
Palo Alto Plastic Surgeon
4.5 out of 5 stars 36 reviews

Sagging neck and jowls one year after full facelift.

Sagging neck and jowls one year after full facelift is not normal for experienced facelift surgeons. I would discuss this with your surgeon and if you do not have confidence in his ability to correct this I would get a second opinion from a very experienced facelift surgeon.   

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 34 reviews

Sagging post face and neck lift

Thank you for your question. It is difficult to answer without an examination and going over your history as some medical conditions and medications can give more laxity postop then others. I would suggest you discuss this with your surgeon and possibly get a second opinion if you are uncomfortable with the discussion you have with your surgeon.

Rick Rosen, MD
Norwalk Plastic Surgeon
5.0 out of 5 stars 22 reviews

Sagging neck

As you are now close to a year after surgery, the result you see is likely your final result.  It would be good to see photos of your face prior to surgery to compare, but I agree that you indeed have return of jowl and neck tissue excess.  I would speak constructively with your surgeon about his/her opinion of the result.  Try not to be confrontational, and I would imagine that they might be willing to try to make your result better with some form of revision surgery.  This is what I would do for you if you were my patient.  Either a different technique or approach than what was done initially could be considered.  Good luck to you.

John Frodel, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Facelifts generally yield an excellent result to the neck.

I'm not sure specifically what type of operation you had based in your description. In general a full facelift includes the neck and one expects a very good result. It looks as though you would benefit from a revision of the lower facelift.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Here are some pre-operative factors that may have caused regression in your facelift. Best to discuss with your original surgeon

As a cosmetic oculofacial plastic surgeon, it is possible that patients can have jowls, marionette lines as well as sagging neck skin after a facelift, which primarily depends on their genetics. Without the benefit of a physical examination and the full details of the actual procedure performed, it is difficult to assess if this is outside the norm.

The terminologies of a mid-face suspension and a superficial muscular aponeurotic system or SMAS lift can mean different things to different surgeons when they are implemented. Clearly, I would suspect that when you chose your doctor, you had done your research and you felt comfortable with your doctor’s ability to perform this procedure. It is understandable that you are concerned if you are not seeing the results.

Within the spectrum of facial cosmetic surgery, I will tell you from 20 years of that certain factors have an impact beyond the immediate post-operative period. If you noticed immediately after surgery that your face and jawline looked very good, sometimes it’s not just about the amount of lift, but also the degree of swelling that has a factor in this process. Sometimes, people look a lot better while there’s a little bit of swelling in the mid-facial area while they’re healing.

If the jawline looked good then it has descended, then we can probably conclude that there’s a certain degree of regression. That regression can be from skin elasticity or tissue elasticity that’s deeper or it can be from a variety of factors. I always explain to my patients that even though I can do a meticulous procedure and do some really good tightening, the human body can still change. If someone has a lot of volume and sagging under their chin then this degree of residual may still be expected. If someone didn’t have as much, then it would be unusual.

I think it is important that you maintain communication with your doctor and discuss these concerns. Most ethical cosmetic surgeons are willing to do any enhancements as indicated in the terms you agreed upon before surgery. Unfortunately, there are doctors who will tell people that they look fine even though they don’t look and feel fine. It is your call to decide whether or not you’re going to seek additional opinions. From my perspective, it is often best that you see the original doctor, who must be good and caring and technically skilled. They know your anatomy and they’re most likely comfortable with doing any revisional surgery. If you’re not satisfied for any reason, then get any additional opinions. I hope that was helpful, I wish you the best of luck, and thank you for your question.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Sagging after facelift

It would be helpful to compare your before and after pictures. From the pictures that you have provided, it appears that you have some residual laxity in the jowls and the neck as well as some contour irregularity in the neck. As has been previously stated, I would sit down with your surgeon and discuss your concerns and see if a revision surgery would be appropriate.

Todd C. Miller, MD
Newport Beach Facial Plastic Surgeon
5.0 out of 5 stars 34 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.