Is this cobra neck deformity? How can this be corrected? (Photo)

Question

After deep plane face & neck lift, I was left with what appears to be a cobra neck deformity. Any advice is appreciated. I need an expert at correction of this problem. Thank you

Jeffrey H. Spiegel, MD · Answer

Yes, your doctor was doing what is very popular right now - removing tissue beneath the platysma muscle to create a very sculpted neck.  These necks are, in my opinion, somewhat unnatural and I don't believe they will stand the test of time. We can help with this. It will require fat grafting and restoring the natural fullness to the neck.

Elie Ramly, MD · Answer

Thank you for your question and for sharing your photograph. In this photo, the appearance under your chin and along the upper neck could be consistent with what is commonly called a “cobra neck deformity”, which can happen after a neck lift surgery. That being said, I would be cautious about making that diagnosis from a single photograph alone and without a physical exam.
A cobra neck deformity generally describes a postoperative contour in which there is central or paramedian hollowing beneath the chin with relative fullness or tissue prominence more laterally on either side. It can occur after a facelift (combined with a neck lift), neck lift, or submental surgery when there is an imbalance between the tissues of the central and lateral neck in bulk and contour.
Several different anatomical factors can create a similar appearance, including over-resection or irregular removal of submental fat, residual unaddressed lateral neck fullness, lack of proper contouring of the surrounding deep neck structures (digastric muscles, submandibular glands - if and when indicated), scar tissue and adhesions, platysma contour abnormalities, skin redundancy, central skin tethering, or a combination of these factors. Determining which structures are responsible is particularly important in revision neck surgery because the treatment should address the underlying anatomy to restore a natural external contour, rather than simply target the visible surface contour.
Depending on the physical examination and what was performed during your original surgery, correction most likely would involve a formal revision neck lift surgery (potentially with a facelift if indicated based on your exam to achieve a more balanced result or to address other concomitant issues from the prior surgery). Careful scar release, fat grafting to restore deficient volume, revision of the platysma, revision of the the deep neck structures (anterior bellies of the digastric muscles, submandibular glands), redistribution or removal of residual fat, are maneuvers that could be relevant in this scenario. In some patients, a combination of these approaches provides the most natural correction.
Timing also matters. If your surgery was relatively recent, swelling, scar maturation, and tissue contraction can continue to change the appearance of the neck. If you are further along in recovery and the deformity has persisted, consultation with a plastic surgeon who specializes in face and neck rejuvenation and is experienced in revision facelift and revision neck lift surgery would be appropriate. Reviewing your original operative report when available can also be helpful when planning a correction.
The encouraging point is that postoperative neck contour deformities can often be significantly improved, but the specific solution depends on identifying exactly which anatomical layers are producing the contour you see.

Is this cobra neck deformity? How can this be corrected? (Photo)

Answers (2)

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