Is a tight choking feeling like an elastic band going from ear to ear normal 6.5 years after a facelift?

Question

After 6.5 years. I still feel like I have a tight choking feeling. Like a band going around my neck. Is this normal? It's a horrible feeling.

Elan Reisin, MD, FACS · Answer

After a facelift and neck lift often times patients do complain TEMPORARILY of a tight sensation across the neck. However, there were older techniques that used a Crossing Stitch across the entire neck which definitely produced some problems down the line with the choking feeling that did not go away. Today, however, we use a different technique where we do not cross the midline of the neck with sutures so the permanent choking sensation no longer occurs. Please consult with your surgeon on this.

John Michael Thomassen, MD · Answer

This is highly unusual.  There are some techniques that involve using a cable suture tied from mastoid to mastoid to support the neck.  You may want to ask your surgeon if this was used in your case.

James H. Rogers, MD · Answer

It certainly is not common to experience tightness or feelings of choking years after a facelift. You do not mention if any permanent sutures or slings were used, as this could potentially cause this type of symtom. A nerve injury is another potential source. I would recommend consulting an experienced surgeon for an evaluation.

Zoran Potparic, MD · Answer

Without in person evaluation it is impossible to give you meaningful answer. Could your surgeon have used a suture extending from behind one to other ear (Gianpapa) to correct your neck deformity? In person consultation with a board certified plastic surgeon with good reputation in facial rejuvenation and face lifts is recommended. Good luck.

Francis R. Palmer, III, MD (retired) · Answer

Hi, no this is not normal following a facelift.  I have performed many SMAS facelifts and neck lifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  That's not a typical result or sensation following a SMAS facelift in my humble opinion.  I have heard of that type sensation resulting from the use of suspension sutures across the neck.  Attached to the mastoid bone on one side of the neck and crossing the neck to the opposite Mastoid bone...these thick permanent sutures can give the feeling of "strangulation".  You may want to ask your facelift surgeon is that type of suture was used.  If so, it can be identified and cut which should provide some relief or eliminate the sensation completely.
 The reality is, there are many different ways to perform a facelift from incision length, incision placement, level of tissue dissection (skin only, SMAS, Deep Plane, Subperiosteal), different degrees of tissue undermining, how to lift and support (imbrication versus plication of the SMAS layer), how much excess skin to trim, is excess fat going to be reduced and finally will the overall shape of the face be made more feminine or masculine (while avoiding the over pulled, windswept appearance).  Price is determined by the reputation, location and experience of the Facelift Surgeon.
 In my humble opinion however, there are some basic requirements that must be met in order for a facelift to be "effective", yielding "aesthetic pleasing" and "naturally attractive" results.  These include: 
 1. Some type of incision either curved around the front (preferred) or straight in front of the ear.  This is how excess skin is removed which is not possible with an incision behind the ear alone.  If you have so little excess skin on the face that "none" needs to be removed you are not a candidate for a facelift in the first place.
2. The facelift must address correction and softening of the "jowls" using a long lasting and effective technique.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
3. Facial shaping must be combined to properly shape the cheeks, chin, jaw line and lips for feminizing or masculinizing the face as the case may be.
 If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection = less bruising and swelling = rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair = no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face.  Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.
Hope this helps.

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