Persistent neck skin laxity after facelift AND revision.

Thanks for your question.  I'm sorry to hear that you have been underwhelmed with your results.  It is difficult to say exactly what could or should have been done without photographs or an inperson evaluation.  However, if you have heavy bands and separation of the platysma/neck muscles, opening the neck with a submental incision is usually helpful.  Typically, this allows the surgeon to remove central fat, tighten the bands in the midline, and shape the tissues underneath the skin.  Then the skin that is removed from the sides of the neck and behind the ear will redrape and provide a smoother neck contour.
While it's not incorrect to keep the neck closed, I find that it is very patient specific and if you have had a recurrent problem, approaching it with the same surgical technique is probably not going to produce different results.  
Good luck,
Christopher C. Chang, MD

I do a neck lift 90% of the time with my facelifts, as this ensures tightening of the platysmal bands around the center of the neck. Sending pictures will be helpful to see whats going on. What you are alluding to is correct. 

As indicated photos would be helpful.   Persistent skin laxity after facelift surgery  can be due to either  factors such as skin quality or relate to the procedure carried out.  You may benefit from more surgery or treatment of your skin with facial laser resurfacing or radiofrequency devices.

Skin laxity in neck after facelift revision surgery can be due to multiple factors. The specific facelift technique is one factor (ex. SMAS, deep plane, etc) and whether the plastic surgeon directly modified the area under the chin to tighten the neck muscles (i.e. submental incision). Another factor is the patient's existing anatomy and tissue characteristics, as some patients may still have a certain fullness under the chin or skin laxity. One example is that some facelift patients would benefit from a chin implant, in addition to neck surgery. Without an in-person evaluation with a facelift surgeon, it's difficult to determine what is "best".

Your question is difficult to answer without examining you and knowing exactly what was done during your initial facelift and the revision.  In most cases, a facelift would address excess skin in the neck and the lower part of the face.  The incision for this procedure would normally begin somewhere around the temple and then come in front of the ear, behind the ear and either into the hair at the side of the head or down along the hairline on the side of the head.  If your incisions were not this extensive, that could be the reason for the laxity in the neck that you are still seeing.  

they are different philosophies as to how to approach the neck. Some surgeons who perform facelifts do everything from around the ear,pulling the neck muscles laterally. Most surgeons use the incisions around the year but also an incision under the chin to tighten the muscles on the anterior neck. This is the approach I use most of the time if there's a problem in the anterior neck because I don't think it's easily corrected just by pulling laterally. Speak with your surgeon about this and if you are not comfortable with his answer, seek a second opinion from a qualified plastic surgeon

This is a good question.  Without photos this is hard to assess.  A Facelift includes the Neck as well and should be improved at the same time.  Both areas are handled surgically at the same time.The Neck is a specialized area that can be difficult.  Surgeons must be experienced in Neck Lifts for the best results. With revision Neck Lifts, surgeons have a tendency to follow the old incisions which usually will give the same result as before.  Usually, this is part of the problem in the laxity of the skin.  The incisions need to be planned properly to remove the excess skin.  If the surgeon does not have that vision, then your result will always be the same.The placement of these incisions with regard to the facelift is important as well.  Both areas are related to each other for the best result.  I always utilize a submental incision as this incision is invisible in the long run..  This also aloows the surgeon to tighten the Platysma muscle as well in the neck with helps insure tightness.  It also allows better access to the neck as well.I hope this helps.  Good luck

Depending on the severity of the skin laxity under your chin, the simplest solution would be to remove the excess with an incision under the chin. There is a limit to how much you can get out due to the length of the incision that one can create. Access to the leading edge of the platysmal muscle through a submental incision can also help create a better contour to your neck. However, a submentoplasty has its limitations, and may require elevation and removal of excess skin from behind the ear. Hard to say why, after two surgeries, you are not getting the desired result. Most likely, just not being aggressive enough with skin elevation and muscle suspension. Sometimes, the stitching of the muscle can tear through and you loose the effect. This has to beal completely (six months) and then be redone.

Without photos it's difficult to say but it could be that a submental incision may be required.  This incision allows repair/tightening of the platysma muscle which contributes to the bands you may be seeing.  It also allows the surgeon to free up and release the skin in the front of the neck to allow for more tightening.  Like Dr. Rand, I usually find I need to perform this incision on patients with a significant amount of skin laxity in the neck to get the best result.

So your two options are, if the laxity is strings of platysma muscle then botox to the bands can be a significant improvement. It sounds more like you have volume in the midline under the chin. This can be sucked out with submittal liposuction or, possibly more likely, you might need an anterior cut and tightening of the muscle at the front with potentially some fat removal at the same time. Ask your surgeon what they thinkHope that helps, Adam Goodwin