I have an uneven skin retraction and vertical bands after chin/neck lipo. What can be done? (photos)

I'm sorry for the struggles you have gone through.It appears you were over-liposuctioned and have very little subcutaneous fat left.The bands you are showing may represent scar tissue or the platysma muscle itself.Some patients with platysmal bands have been successfully treated with Botox.Replacing the subcutaneous fat in the neck with fat grafting will be difficult and virtually impossible to restore to where you were before your surgery.At this point, as previously stated, you need a correct assessment. By contracting your platysma muscle in front of a competent plastic surgeon, he or she will be able to tell you if these bands are from the muscle. If they are, then manipulating the platysma muscle with a surgical procedure may be an option.Considering your outcome from your current surgeon, you may consider a second opinion.If you are to have more surgery, please make sure it's in the hands of someone with exemplary talent and years of experience.My thoughts go out to you.I hope you find what you need to get the correct treatment.Best of luck, Mats Hagstrom, M.D.

Dear Mags88,

Liposuction of the submentum and neck, although seemingly
simple, can be fraught with minor to moderate aesthetic complications, such as
uncovering underlying platysmal bands and adherence of the skin itself to the
underlying platysmal neck muscle. Even
in the hands of the best surgeons, this kind of complication can occur. The approach of the your surgeon advising a
conservative approach in the first few months after surgery is advised. Generally, aggressive massage in the first
weeks or months may help disassociate the attached skin to the underlying
platysmal muscle.

In my own submentum-neck liposuction practice and neck lift
practice of 20 years, when I have had patients with this post-operative side
effect, I would generally begin at approximately six to twelve weeks
transcutaneous radiofrequency skin treatments, combined with high-frequency
ultrasound. This will help tighten any
residual skin laxity and help loosen the potential attachment of the skin to
the underlying muscle.

Once you’ve reached the ten-month mark, however, the laxity
needs to be treated with some type of energy-assisted treatment protocol. In my practice, I deploy a product called the
FaceTite™, which is
subdermal radiofrequency energy, although SmartLipo™ laser fibre can also be used to heat
only the subdermal skin, preserving any residual fat. On top of the skin, fractional radiofrequency
techniques will provide additional tightening.
At this point, your assumption is quite correct – some interpositional
insertion of tissue needs to be performed to try and create a softer appearance
to the adherent skin to the underlying platysmal neck muscle.

In general, micro fat
grafting will often provide a smooth guide plane. This can be performed under local anaesthesia
and, in my hands, has been quite successful at improving the appearance of this
post-liposuction side effect. A full
neck lift would lift the skin, again, off the underlying platysmal muscle. The platysmal muscle can be then tightened,
repositioned and sutured and the skin redraped.
This will often improve the appearance; however, it is a much more
extensive procedure than you had anticipated.
The other technique that I employ non-surgically is a simple
administration of Botox® into the platysmal bands to soften their appearance when your neck is
extended or contracted and disassociates the adherence and creates the illusion
of disassociation of the skin from the underlying muscle. A combination of the above techniques is
often the best solution.

I would return to your
original surgeon, as that is usually the best initial approach, as they will
feel a sense of obligation, as all qualified surgeons do, in ensuring their
patient achieves the best possible result.
If there is a therapeutic impasse between your original surgeon and your
aesthetic goals, then seeking out an experienced neck and facelift surgeon
might be your next step.

Hope this helps and best of luck.

R. Stephen Mulholland, M.D., Board
Certified Plastic Surgeon, Yorkville, Toronto.