I had a facelift to tighten neck in 2009, but the skin is loose again and not matching my face. Do I have any options?

Thank you for your question.  It would be best to speak to a board certified plastic surgeon to properly examine you.  As you age, even after a facelift, there is going to be eventual relaxation of the skin and tissue. It does not completely stop the aging process.  an option may be to do a skin only excision which would be less intense than a full facelift.  All the best,

Thanks for your question. As you've
already discovered, the results of facelift surgery are not permanent -- but
it's wonderful that you enjoyed 7 years of results! Without a photo or
in-person consultation, it's impossible to know exactly which procedures would
best suit you. However, keep in mind that most neck lift procedures don't
require a scar at the back of the neck. Instead, they're typically rather small
and made beneath the chin. Please seek out a board-certified plastic surgeon
near you to learn more about your options.

The neck is the first area to relax after a facelift, for two reasons: 1) The skin and underlying SMAS muscle layer is thinner there and more stretchy, and 2) with normal head turning, there is considerable tension, which results in more stretching. I think it is quite likely that a modified neck lift procedure, which is less involved than a full lower facelift, could give you the results you are looking for, with less recovery. The technique is important: If the deeper tissues are released and elevated, then there will be minimal tension on the skin, and the scars should be fine without risk of hair loss. I suspect that, in your first procedure, the skin was placed under a lot of tension, which can result in hair loss, heavier scarring, and pain.

For skin tightening, there are a
variety of non-surgical options. ThermiTight is injectable radio-frequency,
which works to target the collagen in the skin, and produces a very nice,
noticeable tightening result. Thermage and Ulthera offer non-invasive
tightening with Radio-Frequency and Ultrasound, respectively. Fractionated
Radiofrequency (Infini or Intensif ) is another treatment for mild- moderate
skin laxity in the neck. These are a few options that are worth researching.
You will also want to make sure that whoever is developing your treatment plan
has a good understanding of your goals and expectations. Nonsurgical treatments
are very beneficia; however, they typically do not achieve results that would compare
with surgery. After being evaluated by
your surgeon, you may find that a necklift, with or without another facelift,
may still end up being your best choice.

Without seeing you in person it is impossible to
determine what procedure would best help you. That being said, there may be a
few options available. At my practice I perform what I call a “mini-lift” on
appropriate candidates who are showing early signs of skin laxity, but who do
not yet have heavy jowls or turkey neck. This surgery can be performed while
the patient is awake. This procedure is
minimally invasive, with fewer incisions (and therefore less scarring) required
than a full facelift. Another option may be a non-invasive skin tightening
treatment such as the Titan laser or Ultherapy. These treatments do not require
any incisions or downtime, but be warned that the effects are less dramatic
than can be achieved through surgery.

I
understand your reluctance to undergo another full facelift. Given the issues
you've brought up, a neck lift may be an appropriate way to reverse the loose skin
in the neck. However, it's also possible that you may need another facelift
after all (likely less extensive than the first) to achieve the results you're
looking for. Incisions should not dissuade you from either option, because they
should be very minimal and difficult to see once they heal. I think
the best course of action would be to sit down with a board-certified plastic
surgeon and explain your current situation. He or she could judge which
procedure would make the most sense in your particular case. Best wishes.

The duration of the results achieved with a face and neck lift cannot always be accurately predicted. If the natural degenerative process in the skin is occurring rapidly, wrinkling and sagging will also accumulate more rapidly. This is precisely when “tuck-up” or “spot-welding” procedures are helpful.A facelift generally helps turn back the clock about 10 years in most patients, but it does not stop the ticking. Nevertheless, most patients look forever younger than had they not had the procedure done at all. The excess skin and fat in the neck and lower jaw is removed at surgery. Any slack seen in the post-operative period is a result of continued aging and breaking down of the skin that remains.Without examining you or knowing the specific type of "full" procedure performed on you in 2009 (e.g. skin only, thread lift, deep place face lift, SMAS lift, etc...), it is impossible to speculate what the best revision option for you is. I would recommend consulting with a facial plastic surgeon or plastic surgeon in person regarding your concerns.Good luck!

While a typical facelift usually has an effect for around 8 years, it doesn't stop the aging process.  But you'll look better than your unoperated friends, or if you had never had a facelift.Ask an experienced local surgeon about the options for a secondary procedure.  Most patients find that its an easier experience.All the best,

It seems to me from your description that the neck overall itself is not hanging. Without a picture it is difficult to say for sure, but it sounds like you are more concerned with the texture of the skin describing it as "crepey". If this is indeed the case, you may be able to get the result you want with noninvasive treatments such as laser resurfacing. There are lasers which act on the surface of the skin, on the deeper layers of the skin, and other devices which work deeper yet using radiofrequency. I think your first step is to visit with a board certified plastic surgeon who has options in the noninvasive category. It is important to see a surgeon so that you receive all options from nonsurgical to surgical to get the best one that is tailored to your situation.Best of luck!Dr. SubbioBoard-Certified Plastic SurgeonNewtown Square/Philadelphia, PA

Hello and thank you for your question. It depends on how much hanging skin there is and the status of your platysma muscle. If your muscle requires tightening, then noninvasive techniques such as ultherapy, botox, kybella, are not likely to work. You may require a re-operation with a mini facelift or necklift. But this is impossible to say for ceratin without examining you in person. The most important aspect is to find a surgeon you are comfortable with. With good surgical technique, you could have an outstanding result. I recommend that you seek consultation with a qualified board-certified plastic surgeon who can evaluate you in person.Best wishes and good luck.Richard G. Reish, M.D.Harvard-trained plastic surgeon

It's impossible to comment on your specific case particularly without photographs. However, it's unusual for a well executed facelift to require a revision before 10 years. Most patients don't need a revision at any time.