18 months post SMAS facelift - What could have caused hanging neck skin? (photos)

Hi, thank you for your question regarding what could be causing neck laxity 18 months post-SMAS facelift and neck lift. Thank you for sharing your history and your pictures. Upon analyzing your pictures, it is evident that you have hanging neck skin. It is difficult to pinpoint exactly what was or was not performed during your initial surgery. However, the presence of residual neck skin and fat suggests that a corrective procedure, specifically a neck lift involving the removal of excess neck skin, may be necessary. This procedure may also include a platysmaplasty or plication of your platysma, the neck muscle, depending on the specific needs of your case.

The neck lift is typically achieved by making an incision in front of and behind the ear, with dissection extending to the neck, allowing for the resuspension of the neck skin. This procedure can often be performed through your existing SMAS facelift incisions. The revision surgery should take approximately two to three hours. I hope this response has helped to clarify your options for addressing neck laxity 18 months after an SMAS facelift. Good luck.

Sincerely,

J. Timothy Katzen, MD, FASMBS, FICS
Plastic and Aesthetic Surgeon

To provide an accurate assessment, an in-person examination is essential. Based on your description and photos, the hanging neck skin and altered lower face contour after your SMAS facelift suggest that a revision surgery may be needed. Specifically, an anterior neck lift could effectively address the excess, sagging skin in the front of the neck and improve overall neck definition. Revision procedures focus on correcting issues not fully resolved in the initial surgery to achieve a more natural and youthful neck contour.

Unfortunately this can be common with SMAS lifts. The technique fails to properly lift and address all the deeper structures leaving to skin pulled but not the structure beneath. You can speak with your surgeon about your concerns and obtain your operative report for specifics on what was done during your procedure. It is important to select a surgeon with experience in deep plane facelifts, this may give you a better chance at achieving your desired results. Best of luck.

Thank you for your enquiry and sharing your photographs.
I am sure that if your provider has advised you that they did a SMAS lift, it is actually what they did.
The neck contour, suggests problems with volume from the digastric muscles and submandibular glands. This would be addressed by a deep plane neck lift but it would not be controlled by platysmaplasty or liposuction.
Your photographs suggest a moderate amount of sun damage which leads to reduced elasticity of the skin. It is a significant contributor to the presence of sleep lines in combination with the direction of the lift. To control the lateral sweep, a more vertical vector for the left is likely to be the solution. Deep plane facelift may be of help in your case.
In some instances, in order to control the contours better, placement of the temporal scars in front of the hairline facilitates removal of skin excess in a more vertical direction show.
I would suggest in the first instance to discuss with your surgeon regarding your concerns and find out what solutions they would offer to help you achieve a result that you feel comfortable with. She

The best evaluation of your concerns could be done after a review of your doctors operative notes. From your photos it seems that too much fat was removed directly beneath your chin leaving you with a hollow there. On each side of your chin, below your jawline, it appears that the fat underneath your skin was left slightly thick, and the sweep of the skin across your jawline is due to improper vectoring of the skin during the redraping of the skin during your facelift. This may require a revision in order to correct these issues. Speak to your plastic surgeon about possible options. Best wishes.

Hello, hope you are well. There are a couple identifiable issues from the images that you provided. You appear to have recurrence of skin laxity in the lower face. In the neck, there is unevenness with a central concavity/depression in the midline. This typically happens when the central fat compartment is reduced, but the adjacent muscles (digastrics) are relatively prominent which causes an uneven contour (the 'hanging skin' appearance). You may consider revision surgery to improve these problems.
Best,Dr. Tower