One year post SMAS facelift - how can I fix the jaw and under chin area? (Photos)

Question

I am 53 and had an SMAS facelift Over one year ago. I am unhappy with the jaw and under chin. I have a band of loose skin like a pouch. I complain to the surgeon he told me to manage my expectations and to massage my neck. I hate the way it looks what can i do?

Elie Ramly, MD · Answer

Thank you for your question and for sharing your photos. At more than one year after a facelift, your tissues should generally be sufficiently healed to evaluate any residual concerns you are seeing and consider whether revision surgery may be appropriate.
Your photographs appear to show residual skin and soft-tissue laxity under the chin and along the jawline, with persistent irregularity in neck and jawline contour and definition. That being said, photographs alone cannot determine exactly which anatomical structures are responsible. This requires an in-person examination.
Depending on your examination and what was performed during your original surgery, significant and durable improvement would likely require a revision facelift and neck lift. The goal would be to identify and specifically address the deeper anatomical reasons for the appearance you’re seeing rather than simply tightening or removing additional skin.
In revision face and neck lift surgery, I would evaluate the skin, SMAS, platysma muscle, subcutaneous and deeper neck fat, scar tissue, submandibular glands, digastric muscles, and underlying chin and jawline anatomy. The findings would dictate the best maneuvers to restore a youthful, harmonious appearance to your face and neck and a natural transition from the cheek to the jawline to the neck. This may include a revision deep plane facelift, revision deep neck lift with contouring of the deeper neck structures, and fat grafting. When deeper structural support and contour are restored and lifting is performed in the appropriate vector, the skin can then be redraped without tension or areas of excess laxity.
Given that you are now more than one year from surgery and remain bothered by the appearance of your jawline and under-chin area, it would be reasonable to visit your original surgeon again and/or seek a second opinion and in-person evaluation from a plastic surgeon experienced in revision facelift and revision neck lift surgery. An examination and review of your original operative report would help determine what was previously performed and which options could realistically improve your neck and jawline.

Serdar Bora Bayraktaroglu, MD · Answer

At one year post-op, a pouch of excess skin means the tissue has either relaxed or wasn't pulled tightly enough behind the ears during your original surgery. Massage cannot shrink redundant skin.Since your underlying muscle foundation is sound, the solution is a skin-only revision, which is far less invasive than your primary facelift. A surgeon will reopen the incisions hidden behind your ears, undermine the loose neck skin, pull it backward firmly like a hammock, and trim away the redundant pouch.I highly advise seeking an objective second opinion from a facial plastic specialist to plan this targeted correction.

Ali Riza Öreroglu, MD · Answer

From your photos, it appears that it has been 1 year since your surgery, which indicates that the majority of the healing process is complete, and persistent fullness under the chin and banding in the neck after an SMAS facelift is most commonly related to residual submental fat and/or platysma laxity; in such cases, a deep neck lift, which focuses on reshaping the deeper neck structures—often including platysmaplasty and, when needed, contouring of deeper fat compartments—may further improve the cervicomental angle and jawline definition; however, the appropriate treatment should be determined after an in-person evaluation of your neck anatomy, skin quality, and the specific technical details of your previous surgery to decide whether a revision procedure is truly indicated or whether more conservative options may be sufficient.

Ali Sajjadian, MD, FACS · Answer

Thanks Umshus2012 for your question! It is understandably frustrating to go through a major procedure like an SMAS facelift and still feel self-conscious about a specific area a year later. At the one-year mark, your swelling has subsided and the tissues have settled, so what you are seeing now is likely the final surgical result.
The "pouch" or band of loose skin under the chin after a facelift can sometimes be attributed to residual skin laxity, prominent platysmal bands, or submental fat that wasn't fully addressed during the initial procedure. 
If the primary concern is loose skin, non-invasive treatments often provide only modest results. A surgeon can perform a targeted neck lift to tighten the underlying platysma muscles (platysmaplasty) and remove the excess skin. This is often the most definitive way to sharpen the jawline.
For mild to moderate skin laxity where a second surgery isn't desired, energy-based devices can help contract the tissue. Radiofrequency (RF) Microneedling Combines physical needling with heat to tighten the skin's surface and improve texture.
Hope this was helpful!
Best wishes,
Dr Ali Sajjadian

Don W. Griffin, MD · Answer

Your pictures show residual fullness in the neck area. A Deep Plane Facelift technique really only addresses the face structures. It does lift skin in the jowl areas, but your area of concern is the central neck. The central neck has both superficial and deep fat compartments and patients often have excess fullness of the digastric muscles and submandibular glands. I suspect that your procedure did not address the deeper layers leaving you with residual fullness. A deep neck revision to address these areas will improve your results. A revision to the facelift may also be necessary.

Mehmet Ozdemir, MD · Answer

It is truly disheartening to feel that your concerns are being dismissed after undergoing such a significant procedure, especially since your photos clearly show a "pouch" of residual skin and platysmal banding that a standard SMAS facelift should have ideally addressed. While "managing expectations" is part of the process, a year out from surgery, massage will not resolve what appears to be a lack of deep structural support or an incomplete platysmaplasty (the tightening of the neck muscles). To get the crisp jawline you were expecting, you likely need a neck lift revision that focuses specifically on the submental (under chin) area, involving a direct incision to tighten the midline muscles and remove that excess skin "pouch" that is currently draping over the jaw. I would recommend seeking a second opinion from a surgeon who specializes in deep-plane neck lifts or revision work, as they can more effectively address the deeper fat and muscle layers that seem to have been bypassed in your initial surgery.

Semih Yildiz, MD, FEBOPRAS · Answer

At one year, massage alone usually will not change a true band or pouch of loose skin. In my experience, the photos suggest residual neck and jawline laxity, but an exam is needed to tell whether this is skin, platysma banding, fat, or deeper neck anatomy.
Depending on the cause, options may include a revision neck lift, platysmaplasty, lower-face revision, or carefully selected submental liposuction if fat is the main issue and skin tone is good. I would seek an in-person second opinion from a facelift/neck-lift surgeon and bring your operative details if available.

Carl Truesdale, MD · Answer

Thank you for your question. Based on the photos you shared, you appear to be an excellent candidate for a deep plane face and neck lift. This procedure is designed to address the deeper structural components of the face and neck rather than simply tightening the skin alone, allowing for a more natural, balanced, and longer-lasting result. A deep plane facelift would help reduce the appearance of jowling, restore support to the lower face, and soften the nasolabial folds by repositioning the descended facial tissues back to a more youthful position. At the same time, the deep plane neck lift component improves the underlying muscles and deeper tissues of the neck to create better contour and definition along the jawline and beneath the chin. This approach is especially beneficial for reducing the bulky or heavy appearance under the neck while improving overall facial harmony and rejuvenation. By addressing both the face and neck together, the results appear smoother and more cohesive without looking overly tight or pulled. Overall, these procedures would provide a refreshed, more youthful appearance while still maintaining your natural facial features.

One year post SMAS facelift - how can I fix the jaw and under chin area? (Photos)

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