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?

I usually tell my patients that the results of a facelift is permanent however, it will not stop time.  You probably still look better today than if you hadn't had a facelift at all.  Time has passed and unfortunately you've gotten a little older.  Typically patients who were happy with their facelift will want another one about 10 years later. Some a little sooner, some a little later. Your options today vary depending on how much loose skin you have, what problem areas bother you, and what you are willing to go through.  You can get a full facelift, fat grafting and skin resurfacing, or any combination of the above. The incisions shouldn't really make a difference.  Usually after a few weeks of healing they are very difficult to see even with the hair up.  You really have to decide if the recovery time is worth it for you.  Just remember, the less you do the lesser the results will be and the shorter the time they will last. 

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.