Thank you for your question.
You submitted your question without a photo.
And you’re asking, is 6 or 7 months post op long enough to wait before attempting a
neck lift revision.
And you describe in detail several situations that you are dealing with.
You say you’re 4 months after neck lift with bad results.
And your plastic surgeon wants to wait about 1 year before doing any revision.
You describe the submental area as “bullfrogging out” and that the incisions were indiscreetly
placed in front of your ears and you still can’t cover the areas with heavy makeup.
You also state that you can’t wait for a whole a year but at the same time, you are
recognizing that this area feels tingly, swollen from the sides of the face to the underside
of your chin where there is bulging and the platysmal bands are sagging.
And you are also writing that scar tissue is also likely and you want to know is it
safe to do a revision at 6-7 months even if there is still swelling.
Well, in the absence of a physical examination and more details of the history, I can share
with you my impressions based on the question you’ve described so well.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Face and neck lifting procedures are a routine part of my practice and is part of the wide
range of services we offer to help our patients with facial aging.
So I certainly can share with you my perspective as to what the revision strategy could potentially
be given this situation.
Let’s take it one area at a time.
To begin with, it is important to understand that it is rarely of any significant benefit
to operate on tissue that is swollen and actively healing.
And certainly there is a little bit of flexibility in this window.
But generally speaking, the optimal time to allow for full wound healing is one year.
You know, the wound healing process has very specific timeline.
But further, with face lifting surgery where the skin is elevated away, a lot of work is
done underneath the skin, a certain amount of swelling is part of the process.
Yes, people can look good after swelling diminishes.
And one of my most dramatic cases was a lady who I did her upper and lower eyelid surgery
and face and neck lift 10 days before her son’s wedding and she looked good and she
sent us pictures.
But that’s something that I’m not likely to ever do again even with the different strategies
that I employ to help my patients heal better, heal faster socially.
But at the same time, it is important to recognize that this wound healing process does go on.
You’re describing tingling, that there is swelling.
So at 4 months, this tingling feeling may be a sign of nerves starting to heal and swelling
resolving.
So it’s a window where you’re still dealing with tissue edema or swelling.
Now beyond that, there is this description where the incisions were placed in front of
the ear.
And the reality with face lifting surgery is that a lot of times, although it is optimal
to try to hide the incisions just behind the opening of the ear referred to as the tragus,
it is often a good strategy to also work with the crease that’s already present or if
there’s a very significant difference in the skin quality between the skin at the ear
and in front of the ear to put an incision in front.
Now if you describe a situation where there is very significant issues with scarring,
you might be describing a situation where there’s a lot of redness or the scar is
getting thickened.
Certainly, there is management that can be applied in that situation.
Management such as the use of steroid injections, the use of lasers particularly lasers that
treat blood vessels to diminish the redness.
If you’re not able to hide this so well then you may be able to benefit from something
like this.
There is also regenerative medicine technology that we have employed to help patients who
come to us with scar issues.
We’ve used platelet-rich plasma (PRP), platelet-rich plasma with Acellular matrix.
There may be some potential benefit there.
I think something that does concern me is in situations like yours where people come
to me for a second opinion, very often, where that incision is and the amount of skin that
is removed leaves the patient with a relative skin shortage.
And a lot of times, there isn't room to remove any more skin or revise that scar.
I’m not saying that it applies to you but that is something to be aware of.
As far as the under the chin area in terms of bulging and the platysmal bands sagging,
it may be that you may have gotten more of a limited facelift instead of a face and neck
lift.
Now of course without the examination, that’s just a conjecture.
But generally speaking, at the conclusion of a face and neck lift procedure, the neck
angle can be really sharp and really beautiful.
And essentially, the golden rule applies that if it doesn't look good at the table, it’s
not going to look good when the patient is out of the operating room.
So I would discuss this with your surgeon whether or not they did a neck lifting procedure
where the incision is carried behind the ear to address the sagging skin under the neck.
This is what first comes to mind when I read that you had some swelling or “bullfrogging”
where there’s a lot of extra skin under the neck.
It is an area that may have not been initially perceived as being significant enough to address
with the more extended neck lift procedure.
So I would expect that you went to a plastic surgeon who has extensive experience with
face lifting procedures.
You know, when people meet with me, they want to of course understand my experience with
doing these types of surgeries and the level of expertise and just get a sense of how comfortable
I am with these types of procedures.
And I think that more than likely, you did the same when you interviewed your doctor.
So it is important to at least maintain this dialogue and get your doctor’s feedback
as to what may be the explanation as to why things have gone in this direction.
You know, with a question like this, there is an open question in mind about whether
or not you have a smoking history, whether there is an issue with diabetes or whether
there is a problem with healing or were there any complications during the surgery or after
the surgery.
So if you feel comfortable with this dialogue with your doctor and if there are details
that are still relevant to the way you’re healing that can be discussed and a strategy
developed with your doctor, then of course, revision surgery is going to be appropriate
with the same doctor.
I think that you have to maintain this rapport and get a sense of where you are in terms
of this process and what can you expect after any revision surgery.
I think that most of my colleagues who perform facelift, neck lifting surgery will all acknowledge
that a lot of times, a certain amount of relaxation occurs with any neck lift or facelift procedure
because of the elasticity of the skin.
But at 4 months, of course this is not something that is generally typical and there is a certain
amount of healing that still remains to occur.
So again, have this dialogue with your doctor.
Discuss things that you can do short of a full revision operation that can help with
the healing process and maybe there can be things that can help to get through this period
until revision surgery is performed.
So I hope that was helpful, I wish you the best of luck and thank you for your question.