Could too much fat have been removed from my neck? (Photo)

Question

7.5 weeks ago I had a SMAS platysma facelift. One of the things my surgeon did was remove 1/2 tsp of fat from my neck (I wasn’t sure why as I’m thin & did not have a fat neck prior to surgery + only had the beginning of a “turkey neck.”) Immediately after the surgery my neck felt overly tight + like it was just skin & bones. It still hurts + there are now lines (bands? Scar tissue?) and feels tight /tender. What can I do to resolve this?

Michael Boggess, MD · Answer

Hello.  Thank you for your question.  You are still relatively early in the healing process following your facelift.  It is very normal, and expected, for the neck to feel very tight, swollen, and sometimes a little lumpy in the early postoperative period.  These things will typically resolve over time, as there will be some natural relaxation that will occur as everything heals, repairs, and smooths out after surgery.  There does not appear to be over-resection of fat from the neck in the picture that you provided.  It is not uncommon to do some conservative sculpting of the neck and jawline with liposuction during a facelift, even in relatively thin patients.  The 1/2 tsp of fat that you described that your surgeon removed with liposuction is actually a minimal amount.  The bands that you see in your neck are the underlying platysma muscle.  It is not uncommon to see these with the neck in an extended position that you show in the picture, especially in thin patients, because the skin is pulled tight over the muscle.  If the bands of the platysma muscle remain prominent with your head and neck in a neutral position once you have completed healing from your surgery, then botox injections can be used to relax the muscle.  I would encourage you to communicate all of your concerns to your surgeon and be patient with the healing process.  I wish you the best in achieving your aesthetic goals.

Gurkan Kayabasoglu, MD · Answer

Hello,In the early postoperative period, it is very normal to exprience feeling very tight and swollen. If  your platysma is sutured in your mid-line, a small amount of fat is  removed from between the muscles, to improve the contour and facilitate closure of the muscle. The muscle closure might create a temporary contour irregularities. However, fat removel between muscle shout not create that.You need to follow up your surgeon and given instructions.

Paul M. Steinwald, MD · Answer

. . . with just this one photo, but looks OK overall, as some "new normal" tightness is certainly to be expected, and will relax (sometimes a bit too much . . . ) Also, that positioning and any platysmal "flexing" may accentuate what you're seeing. Time is on your side with these things; better to assess closer to 3 months out at minimum, in a neutral position, and in comparison to your pre-op photos - my guess is that you'll be pleased (and that "turkey neck" definitely will be gone)!)

Paul Lanfranchi, DO, FAOCOO · Answer

Every surgeon tackles the area under the chin in a different way (both technically, and philosophically). Some are more conservative and remove only modest amounts of fat.  Others are more aggressive and take every bit of fat (potentially leaving the muscle visible underneath).  Additionally, depending on the amount of plat muscle drooping, some docs will either remove or tighten the muscle under the chin.  Depending on how this is performed, it my leave irregularities.  The point is that there are so many ways the work could have been performed.At this time you are certainly in the early-mid stages of healing. You should keep in touch with your PS since there are treatments potentially that can help this healing along (ie wearing a headwrap, ultrasound, steriod injections).  That said, what you have may very well still be normal healing based on how your surgeon does the procedure.  Your PS will be better able to assess this, so I advise a follow up with him/her as soon as reasonable.

Trevor M. Born, MD · Answer

Dear jellybThank you for your question and photo!  The healing takes time- you are seeing some bands of the muscle- which may be thickened a little.  Please see your surgeon for follow up!With Warm RegardsTrevor M Born MD

Ronald J. Edelson, MD · Answer

Everything you mention is typical of the things patients feel at this point after a face lift.  A tight feeling,  lumpiness under the chin are typical at this point.  This will gradually improve over time, but most patients notice he same thing as you are.

Henry Wells, MD · Answer

Thanks for your question. If you were thin to start with, small contour irregularities would not be unusual and should improve with time. If  the platysma is sutured in the mid-line, a small amount of fat will be removed from between the muscles, to improve the contour and facilitate closure of the muscle. The muscle closure may create a temporary contour irregularity, but the fat removal between the muscles should not.

Eric W. Cerrati, MD · Answer

From the limited photo, it seems that the "lines" are the underlying platysma muscle, which is common to see in thin patients.  It is also completely normal to have a tight sensation across the neck as the muscle appears to have been bound medially and then pulled laterally.  I recommend that you continue to have close follow-up with your surgeon until all of your concerns are addressed and resolved.
Best of luck.

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