6 months post face, brow and neck lift. Unhappy with neck and face lift results (Photo)

Question

I had a brow, face and neck lift six months ago, and I am unhappy with the bulges under my neck, and the fact that I still have jowls. There is definite improvement, but I don’t know if I should ask for a revision or if this is normal.

Brian K. Machida, MD, FACS · Answer

The large bulges on each side of the neck are likely to be salivary glands.  Jowls are defined as bulges along the jawline.  Your jawline is smooth, and you have no jowls. The bulge in the midline is likely a suture knot if a platysmaplasty was done.  The horizontal band may be due to a horizontal pull of the tissues impeded by the large salivary glands.  The latter two problems may resolve with more time. However, salivary glands will not resolve.  If your surgeon is not familiar with salivary gland reduction, a revision may not help.  Salivary reduction is not without its risks, such as severe delayed bleeding, and saliva collection under the skin lasting months, and is not an innocuous solution.

J. Timothy Katzen, MD, FACS · Answer

Hi nvgurl,

Thank you for reaching out with concerns about neck bulges and the potential need for a neck lift revision after undergoing a face, brow, and neck lift. I appreciate the insight from your medical history and the photographs you provided. I strongly recommend scheduling a follow-up with your original facelift surgeon. It's crucial to articulate your dissatisfaction, while also maintaining "realistic expectations." Without a pre-operative baseline for comparison, it's challenging for me to gauge if a revision might have always been in the cards. The decision to undergo a neck lift initially would have heavily relied on the degree of excess skin present in your neck before surgery.

From what I can assess, there seems to be potential for mild to moderate refinement. There are several paths forward: you could consider non-invasive treatments like Morpheus 8, or delve into the prospect of a revisionary neck lift. By the 6-month post-op mark, the majority of neck tissue typically settles, but if you're inclined to take a more cautious approach, there's no pressing need for immediate revision surgery.

In conclusion, I advise revisiting your plastic surgeon to discuss your observations. If both you and your surgeon concur that further improvement is attainable and you're comfortable with another procedure, a revision neck lift could be the next step. I appreciate your diligence in seeking guidance on the bulges in your neck half a year after your comprehensive facial surgeries.

Best wishes on your continued journey,

Sincerely,
Dr. Katzen

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

The images suggest volume of the submandibular glands and digastric muscles, which is still affecting the appearance of the neck contours, and therefore the relationship with the jawline and face.

The deep plane neck lift intervention tends to address these matters more effectively.

In general, the skin excess which is situated under the chin is addressed more effectively with a more vertical vector for the facelift, but it is possible that this was already carried out and your surgeon would have the answer.

If your surgeon does offer deep plane neck lift interventions, it is possible that this would be a reasonable pathway to follow.

Gianfranco Frojo, MD · Answer

I would meet with your surgeon and express your concerns. If a patient of mine had this outcome, I would recommend a secondary facelift/necklift.

David Hansen, MD · Answer

From the photos, you should do great with just getting a platysmaplasty under local.  It should fix the neck really nicely and is quick and easy to undergo.  6 months is plenty of  time to have waited to get it fixed now.

Thomas Trevisani, MD · Answer

Based on limited photos- the result appears to be less than optimal. We like to see a smooth, tight neck contour. However, it could be a fluid accumulation . I suggest that you discuss it with your Operating Surgeon.

Jacob Tower, MD · Answer

Hello, hope you are well. Sorry to hear that you had a disappointing experience, and I think it is reasonable to seek further improvement. From the photos, the neck bulges appear to be from deep neck muscles and/or the submandibular salivary glands. These can be challenging areas to treat. The first thing you should do is communicate your concerns with your surgeon to seek their advice, because we all want our patients to be happy. Revision surgery may be considered, but you would likely be encouraged to wait for another six months so that the healing process can mature. 
Best,Dr. Tower

William Portuese, MD · Answer

A full set of facial photographs from all angles with your head in a chin neutral position are required to make a determination about what's going on. The very limited photographs appear to have a bulging submandibular gland, but that will also need to be confirmed on physical examination.

Darryl J. Blinski, MD · Answer

Based on the 2 lower face posted photos & without any before posted photos my guess is a very limited mini face/neck lift only was done. I recommend full open revision face/neck lift with SMAS plications. Fees from $12,000++++. Best to virtual consult with....

6 months post face, brow and neck lift. Unhappy with neck and face lift results (Photo)

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