Is this cobra neck? What can I do to fix it? Do I need a revision? (photos)

Question

I'm about 5-6mo PO face and neck lift with platysmaplasty. I'm shocked by how much extra skin after swelling resolved. I don't like how long my face is, but not interested in spending thousands year after year on fillers (hence the facelift.) You can see I have a depression under by chin with the extra skin next to it on both sides. More in my left that my right. My left skin doesn't feel like it's attached to my muscle. It slides very easily over my jaw. Do I need a revision?

Ritchie Younger, MD · Answer

First-Great photos and kudos to you for having reasonable lighting to outline your concerns!Second-You are 6 months out having a Face and some form of Platysmaplasty performed, and by your very skilled description of your face and neck appearance-it is clear  that you have not yet completely transcended thru your healing phase.  This is evident  by some degree of fixation and cavitation by your descriptors and photographs, and for this reason I would clearly wait at least another 6 to 10 months to see what transpires with your contour issues.  Any surgical intervention at this point would not be particularly helpful, since any  revision facelift surgeon would not be able to assess baseline contours, and most likely would aggravate your variation on the theme of volume asymmetries,  that are  clearly bothering you currently.  I would watch and wait and suggest a hard pass on any revision surgery at this time!

Gianfranco Frojo, MD · Answer

Yes, I would highly recommend a revision with potential fat grafting. This can happen when there is excessive resection of the fat on the skin of the neck flap. Or this may be due to over aggressive tightening of the neck muscle with inadequate skin resection. I would highly recommend seeing a board eligible or board certified plastic surgeon for a physical exam and accurate analysis with safe recommendations for potential surgical options. Best of luck!

Zoran Potparic, MD · Answer

This type of deformity may be occasionally seen for several months after surgery. Adherence of the skin to muscles and fibrosis of the muscles after platysmoplasty may be contributing to it. Injection of Botox and Kenalog may help this condition temporary decreasing activity of platysma muscle and due to a beneficiary effect that both medications have on scars.  I would advise against any additional surgery for at least 6-10 months. Good luck.

Fernando Colon, MD · Answer

Overall you had a nice result. The underside of theneck may benefit from fat grafting with or withoutrevising the platysmaplasty depending on what wouldyour in person evaluation reveals. I would suggest to waita minimal of 12 months prior considering a revision. Best wishes.

Gurkan Kayabasoglu, MD · Answer

Hello,
Thank you for your question and provided photos, based on them you seem overall very good and you seem to have platysmaplasty that can be re-sutured. You can benefit from fat grafting, if there is complete lack of subcutaneous fat  and some additional skin tightening can be performed as well.
However, to make certain assessments you need to have a detailed physical examination and face analysis. You goal can be achievable by a professional facial surgeon.
Kind Regards,

Michael P. Morrissette, DDS, FACS · Answer

It is difficult to give you advise based on the photos alone but there are several treatment options. A small revision can be performed to remove some extra skin, or the platysmaplasty can be re-sutured. Fat grafting can be performed if there is complete lack of subcutaneous fat from overzealous liposuction. Some additional skin tightening can be accomplished with radiofrequency devices, J-plasma or even CO2 laser skin resurfacing. Sometimes a simple treatment can make a big difference.

Ronald J. Edelson, MD · Answer

Thank you for the question. The photo with your chin raised shows a central band which is likely the platysmsplasty. However you do have two lateral bands as well and it’s tough to explain why without an I person evaluation. Perhaps the platysmsplasty can be redone and this could be performed under local anesthesia.

Karan Chopra, MD · Answer

I understand your concerns about the appearance you're noticing, sometimes referred to as 'cobra neck,' following your surgery. It's not uncommon to observe this type of temporary distortion for several months post-surgery. This can occur due to skin adherence to muscles and fibrosis in the muscles after platysmoplasty.

In addressing this issue, a combination approach might be beneficial. Injectable treatments like Botox and Kenalog can provide temporary relief by reducing the activity of the platysma muscle and benefiting scar conditions. These interventions can contribute positively to your situation.

It's important to note that patience is key in situations like this. I recommend refraining from any additional surgery for a period of 6-10 months. This timeframe allows for a more accurate assessment and ensures that any necessary action is taken based on a well-informed decision.

If you have any more questions, feel free to reach out to me at chopraplasticsurgery.com.

Christian D. Jacob, MD, FACS · Answer

That doesn't appear to be a cobra neck deformity to me based on the second picture. Platysmal bands can be persistent or change to a different area in the neck. This can happen during recovery from surgery or even without surgery. A small amount of targeted neuromodulators can be very helpful. As to excess skin, there will always be some redundancy when you bend your neck/chin in certain positions. This was present even in your teenage years. To help improve skin texture and tone, a good skin care regimen and semi annual laser or radiofrequency treatments can greatly help.

Sybile Val, MD - Account Suspended · Answer

You look great overall.   Wait at least 12 months from surgery to explore the option of neck revision.   You may be a candidate for minor fat grafting.

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