Best Solution for Redundant Lax Neck Skin After SMAS Lift?

It’s not unusual to see a small amount of loose skin return after a facelift, as unfortunately a surgical facelift cannot address actual skin quality. If the amount of lax skin that has returned is small enough, you may benefit from a non-surgical skin tightening option such as the Titan laser. Otherwise, a minor revision necklift may be done at least a year following your previous facelift. I would suggest discussing your concerns with your plastic surgeon to come up with the best plan. I hope this helps.

A small amount of relaxation of skin is normal and expected after a facelift.  This generally begins to show around 3 - 6 months after surgery but it is a small amount and occurs as a result of 'give' from the skin stretch from the surgery.  Depending on how you're aging, genetics, skin quality, the skin excess may increase with time even as soon as 2-3 years.  It sounds like you have a good rapport with your surgeon so I would reapproach him and discuss your options.  If you are a candidate for nonsurgical tightening modalities, he or she will discuss this with you though these devices are based on a certain amount of elasticity innately present in the skin and this decreases with age decreasing the effectiveness of these devices.  Getting a 'tuck up' with the same surgeon will be best option if this bothers you as he or she will most likely discount the procedure since you had the first one with them as well. 

If laxity is minimal, you may want to consider Ultherapy. Ultherapy is a great non-surgical way to treat minor sagging skin. If the sagging is significant, then you may need a limited revision facelift. Discuss this with your plastic surgeon as he can asses your situation. 

A facelift addresses the jowl and neck by tightening the underlying SMAS and platysma. The neck improvement depends on how extensive your surgeon addtiionally addressed this area. For example was a separate incision made under your neck and a playtysmaplasty done?Was there extensive undermining of the skin in the area of the "turkey waddle", etc. Each of these maneuvers improves the result if applicable to you.

Also realize that in most cases after the  swelling resolves afterwards together with the  natural loss of elasticity in most patients, subsequent skin relaxation to a degree will be seen in some patients.Three to  six months after facelift surgery is when this usually is apparent. This can be corrected if desired in most cases

It's great that you're pleased with the results of your facelift.  Small revisions can be done around 8-12 months after the initial surgery and all of the swelling has resolved.

This commonly occurs.  Before making any further decisions for treatment, consult your plastic surgeon about the possible presence of platysmal bands.  The platysma muscle is a thin muscle underlying the skin of your neck.  If you have separation of this muscle in the midline, it can be seen as a fold (or more commonly two folds).  Suturing of this muscle may be required to obtain a more long-lasting result (platysmaplasty).  More skin tightening may be required, but the anterior neck skin fold may appear again unless the platysma muscle is repaired.  Your surgeon will have to determine when this could be improved.  I generally wait a minimum of 6 months before undertaking additional cosmetic surgery in the same area.     

All patients experience some skin looseness after facelift surgery as the swelling goes down. If however there is a fair amount of skin that hangs down as sounds in your case, you very well may need to have some form of neck lift procedure done.

Best to have your Surgeon examine you and see what needs to be done - it might be s simple as removing some skin under your chin or may be more involved in that the neck muscles may need tightening and extra skin needs to be removed (usually from behind the ear).

In some cases there are no neck issues and the Surgeon can remove your extra skin by using the top part of your facelift incisions to lift up and tighten the are under your chin.

Any which way a visit with your Surgeon to discuss will be of great help to you.

Thanks,

Dr. J

The SMAS facelift is an excellent technique for repositioning the facial fat and supporting the tissues of the neck.  The skin loses its elasticity over time and some of that inelastic skin is removed with the facelift.  However there is a limit to how much skin can be removed because the excess tension on the skin may compromise the blood supply to the skin.  It is not uncommon for there to be some rebound laxity of the skin especially in the neck.  For a small amount of laxity you may get some improvement with a fractionated CO2 laser treatment of the neck.  For more substantial laxity you may need a revision of the neck lift.  I would wait at least a year prior to performing any further surgery.   

You likely had a platysmaplasty or a neck tightening procedure along with the face lift which sometimes can exagerate the skin excess. Sometimes the skin tightens alittle bid as scar tissue matures but if it persists or worsens there are several options. Nonsurgical options are Fractional CO2 LASER resurfacing which can improve skin texture and tightness, radiofrequency treatment like Thermage or Triactive which will require multiple treatments and results may be temporary. I find that excision of skin under the chin can cause "dog ears' along the sides of the chin. T-neck or Z-plasty are good options for men with significant anterior neck skin excess but I believe they result in a scar that is too visible for most women's comfort. Lastly, the best option may be to redrape the neck skin but reopening the incision behind the ears and redraping the skin and excesing the skin excess from behind the ears. I find that when the skin has been completely elevated off the underlying myscle or the platysma muscle was not closed well in the middle before suspending it laterally, this type of skin laxity can occur. I recommend discussing this with your PS and reviewing your options.

Hello and thank you for the question.

Following a facelift procedure there is always an element of skin laxity that returns and can be expected several months after the face has reached a stable state.

Facelift procedures, while designed to reposition the internal soft-tissue structures and thus produce a more youthful and refreshed post-operative appearance, do not in themselves address the actual skin/soft-tissue quality which becomes compromised during the aging process due to both intrinsic factors ( large weight fluctuations, chronic illness, genetic predisposition ),and environmental factors such as photo-aging and smoking, among others.

Subsequently, in my practice,I offer concomitant treatments aimed at fortifying the skin and soft-tissue in order to produce improved results. These modalities include both topical and oral nutriceauticals, derma-roller therapy, and fractionated laser resurfacing, all aimed at improving the integrity of the skin.

Kindest Regards,

Glenn Vallecillos, M.D., F.A.C.S.