Which procedure would help enhance my neck lift results? 1 year post op (photos)

Question

I’m 66 years old, 1 year post op, I had midline platysmaplasty. At 3 months, (all pictures attached) I went back asking if we could do a revision. They suggested fraxel lasers and to come back for year consult. I have done 3 of the laser treatments, and went back for year end consultation. Surgeon said nothing more he can do, possibly revision in the future but not now.

Gianfranco Frojo, MD · Answer

I would perform a secondary face/neck lift. You need to redrape the excess skin of the neck and lower face to properly get the skin to have less redundancy/wrinkling.

Raffy Karamanoukian, MD, FACS · Answer

Ultherapy is a non-invasive procedure that lifts the neck, chin and brow, and improves lines and wrinkles on the upper chest. As we age, collagen breaks down, resulting in loss of skin strength and elasticity. For tissue tightening, Ultherapy is ideal for the lower face and neck and we often combine it with CO2 laser or Morpheus8 to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Lucian Ion, FRCS · Answer

Thank you for your question and sharing your photographs.

The sequence of images suggests a significant improvement in the platysma muscles which is likely to be a long-term benefit to you and still considerable problems related to sun damage of the neck skin.

If when you lie down completely flat without a pillow and examine your facial and neck contours you are able to notice a degree of improvement in the neck skin that you feel would address your concerns reasonably well, it would be worth discussing the option of her repeat necklift in combination with a facelift procedure because the facelift can also help to absorb some of the skin excess in the neck.

If when you lie down completely flat the appearance of the neck skin is relatively similar to when you're standing up, most of the problem will not be related to displacement but rather to the degree of sun damage affecting the skin and nonsurgical treatments would be potentially a better course of action.

My best guess would be that there is potential scope for a re-tightening for the neck skin but analysis from photographs can be quite tricky. It it is worth discussing these points with your surgeon.

Philip S. Schoenfeld, MD, FACS · Answer

The photos that you have provided are not labelled but I assume the far left where you have prominent platysma bands is your pre op photo and the far right is your current status.  The improvement in the laxity of the neck skin and muscle bands is impressive but the condition of your skin is still an issue.  No surgical intervention will correct for this issue and laser treatment, though good, are not perfect and need to be performed with great care in the neck due to the thin and fragile nature of neck skin.

Lexie Wang, MD · Answer

Hi dukes. That depends on what you are looking for in terms of "enhancing" your result. The horizontal lines and pigmentation and texture all look like they are a skin issue, which a surgery cannot reverse, and you should look into getting on the most aggressive skin rejuvenation that your skin and budget can tolerate- this may involve more lasering, microneedling, peels, resurfacing, etc. This will take quite some time and patience on your part but that's because skin slowly picks up damage and slowly gets rid of it, and a lot of what I see seems to be sun related damage to your skin itself (I can see it extending even into your decolletage area on your last picture). If you don't like the two central bands that I really only see in your first picture, then this could be something addressed with another quick surgery and/or botoxing the platysmal bands here.

Nancy de Kleer, MD, FRCSC (Plast) · Answer

The midline platysmaplasty you had nicely improved the vertical bands just to the sides of the midline of your neck, and I see less laxity there as well. This is what a platysmaplasty does. 
The skin quality makes the neck still seem wrinkly.
It has taken years for your skin to develop the fine wrinkles that are present, and it will take a very long time to help them fade, particularly as we are all still aging. Surgery can't erase them.
Medical grade skin care along with fraxel or other laser treatments will make a big difference to improve the skin quality.
I am not clear if you also had a cervicoplasty (this uses an incision along the hairline on the neck) with your platysmaplasty. A cervicoplasty also helps tighten the skin on your neck. 
I agree with your surgeon, no further surgery now, however focus on the skin quality, with medical grade skin care, lasers, avoid the sun, and living a healthy lifestyle with no smoking, a healthy diet and exercise. 
All the best to you,
Dr. Nancy de Kleer

Darryl J. Blinski, MD · Answer

After reviewing your nicely posted post surgical photos in my opinion, a revision of the neck lift to re-tighten. The neck skin is indicated do you have previous Sund damage to your skin of your face and neck? Best to do virtual consult with.

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