I had a parotidectomy. I see that face lifts should be considered with caution. What about a neck lift?

Question

I had a parotidectomy (benign) 18 years ago. I am considering a neck lift for sagging skin on my neck as well as liposuction. The procedure that the surgeon is considering would pull the skin back, remove excess skin, and suture behind the hair line. Also, removal of excess fat at the top of my neck via liposuction. I am not considering a face lift. Is there a risk to the facial nerves with these procedures?

David W. Rodwell III, MD · Answer

A history of parotidectomy will make the technical aspects of a necklift or combined facelift / necklift a bit more challenging.It is important that your necklift surgeon be very familiar with parotidectomy.  You will find that most facial plastic surgeons have a background in head & neck surgery from their residency training which involves a tremendous amount of surgery on the parotid gland and other deeper structures in the area.  Sticking with just a necklift should not pose too much of an increased risk for you.  It really depends on what was done during your parotid surgery and what is found at the time of your upcoming necklift.  Your surgeon should be comfortable in recognizing those variations in anatomy at the time of the procedure and being able to adapt as needed to give you a great result while keeping the risk to a minimum.

Richard G. Schwartz, MD · Answer

Your question is very appropriate, in that parotid gland removal can expose certain branches of the facial nerves in the cheek and upper neck, potentially increasing risk of nerve damage during a facelift.  However, a necklift has more limited dissection than a complete facelift and the area of danger to the facial nerve is much smaller.  Therefore, the risk is also less.  The surgeon needs to consider the possibly altered nerve anatomy when  doing such a necklift.  You should seek out a plastic surgeon with expertise in face/neck lifting, and I do feel that a necklift can be performed very safely with minimal risk of nerve injury.

Elizabeth Whitaker, MD, FACS · Answer

Juju58,

Thank you for a excellent question.  The risk to the facial nerve would be less with just a neck lift than a facelift, but both can be potentially performed safely with an experienced surgeon.  The extent of parotid dissection and removal with your original surgery also impacts the risk.  It is important to consult with an experienced facial plastic specialist who specifically has experience performed this surgery after parotidectomy.  I hope that helps!

All my best!  Dr. Elizabeth

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion.  Seek in-person treatment with a trained medical professional for appropriate care."

Larry Weinstein, MD · Answer

Best results for a neck lift is a face lift with SMAS. It has been proven to give the longest lasting results and best overall results. There is a slight risk of nerve injury, statistics reveal less then 1% incidence of even temporary nerve dysfunction postoperatively by board certified ASAPS plastic surgeons. Consider seeing a qualified plastic surgeon in consultation. Good luck...

Scott Trimas, MD · Answer

The short answer to your question is that there is some risk to the facial nerve both temporary and permanent. However, if your surgeon is skilled in facial nerve anatomy, the risk should be very small. Some temporary nerve weakness is possible just from stretching the nerve or pressure from the surgery itself. That being said it usually returns within six weeks. A neck lift has slightly less risk; however, the lower branch of the facial nerve such as the cervical branch is more superficial in the neck and in general is the nerve that is most at risk especially after a parotidectomy which is superficial for benign tumors. I would make sure your surgeon is skilled in facial plastic anatomy. Good luck in your area.

Jason Emer, MD · Answer

There could be a risk, but it the procedures you outlined aren't contraindicated. VASER and ThermiRF are great for fat removal, tightening the skin and contouring the jawline. I recommend a formal consultation with a facial contouring expert. Best, Dr. Emer

Stephen Prendiville, MD · Answer

Due to the exposure and dissection of facial nerve branches necessary during a correctly performed parotidectomy, caution must be exercised in a facelift procedure.  However, it is not necessarily contraindicated.  If you truly have cervcial skin excess, etc. that would normally call for a facelift, an isolated necklift may be a very disappointing procedure.  The only way to come up wit the best plan is via a consultation. It would be helpful if you can obtain a copy of your operative report.

Miguel Mascaro, MD · Answer

Great question.  A parotidectomy usually entails whats called a "superficial parotidectomy" whereupon the lobe containing the tumor is removed - in benign cases it most often is the superficial lobe.  In order to preserve the facial nerve during this surgery, your surgeon finds it, then traces it as the lobe is being removed to ensure that it remains intact.  That being said, the location of your benign growth will determine the extent of parts of the dissection - if it is located in the most inferior part of the parotid gland, then the dissection will ensure the marginal mandibular nerve will be protected (this is the nerve that controls the corner of your mouth).  This nerve in particular drops down below your jaw and into your upper neck slightly before coming back up to innervate the corner of your mouth.  A neck lift as you describe, by a surgeon who understands the post-surgical anatomy in someone who had a parotidectomy, should be fairly safe.  The more important thing in this situation is to ensure that your doctor understands that you had a parotidectomy before (and it sure sounds like you all had a discussion about this in detail), as well as that he has confidence and experience in this type of post-surgical neck.  I hope I helped answer some questions for you.  Best of luck! It sounds like you are very informed - remember you will always be your best advocate.  I wish you well.

William Portuese, MD · Answer

In our practice, we have performed face and neck lifts successfully after a parotidectomy without any facial nerve complications. There is a slightly higher risk profile, since the surrounding facial nerve anatomy has been altered with the Parotidectomy. When patients have excess and sagging skin in the neck, a lower face AND neck lift is required. For more information and many  before and after facelift examples, please see the link and the video below

Darryl J. Blinski, MD · Answer

Whether face or neck lift the side of the previous surgery needs to be approached carefully to avoid facial nerve injury.....

I had a parotidectomy. I see that face lifts should be considered with caution. What about a neck lift?

Answers (11)

More Neck Lift Questions

WE SEND PRETTY
EMAILS

Answers (11)

More Neck Lift Questions

How can a too tight neck lift be repaired?

Will the puckering on the bottom edge of my platysma scar flatten out and what is the pocket to the left of my chin? (photos)

Neck Lipo or Platysmaplasty or "Neck Lift"? Pros and Cons?

Horizontal neck bands, would a Neck Lift Surgery help? (photos)

What are the newest and best procedures for jowls and neck sagging 2016, not from 2008?

Laser lipo; My neck looks worse now then before the lipo. Is there anything that can correct this for me? (Photo)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS