Thank you for your question!
You submitted two photos and you’re asking if after three neck lifts with revisions,
is it safe to have another neck lift to lift the lower neck and jowls.
Well, I can certainly share with you my approach to situations like yours in my practice.
A little 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 lifts are a very significant part of my practice as well as non-surgical
options to help with facial aging changes which is when people seek out this type of
surgery.
So the first question I would ask someone like yourself is what exactly are you looking
to try to improve.
With the photo you submitted, and I would look at the area that you refer to as jowls
from the front, it doesn’t appear to me that you have significant jowling.
What I would to maybe offer is a perspective for you is an awareness that I’ve had for
many years and at this stage, at this point of time at this stage of my career, I’m
very happy to report that there are options that are better than they were 15-20 years
ago.
So to begin with, let’s start with the definition of a jowl.
A jowl is usually a result of loose skin and some fat this below the jawline which is why
it is indicated to do a face or face and neck lift.
When someone complains about jowling, very often what they aren’t appreciating is that
there is loss of bone in an area called the mandibular notch.
Now that makes the area next to it look elevated or more prominent and people think it’s
jowling.
So what happens is that people, a lot of times people feel that their skin needs to be tightened
and the surgeon would try to tighten the skin and the patient would still feel that they
have a jowl.
So to address an area of deficit in the bone structure and understanding that facial aging
is a combination of descent or sagging and volume loss, there’s a strategy that we
employ called structural volumizing.
What does that mean?
We’re actually using fillers that are placed in this level between the bone and the muscle
that fills out this area and improves that area of bone loss which is below the muscle.
Now this is an area, I can also offer patients a permanent solution such as a pre-jowl implant
or if someone has a weak chin, we can put a chin implant in that place because the tail
of the chin implant actually fills in that part of the area.
Now that’s one part of the equation without needing another surgery.
The other part of this equation has to do with skin quality.
Many people after surgery will complain that they had a surgery done and their skin is
still loose and that the doctor didn’t tighten the skin enough.
I can assure you that most, myself and my colleagues who perform facelift and necklift,
we do our best to make the skin as tight as is appropriate without over tightening or
creating those undesirable tension lines.
So why do people feel this way?
It has to do with skin quality.
The actual makeup of the skin, the loss of collagen actually makes the skin stretchier.
So when it comes to skin quality, you’re not going to benefit from just more pulling
and lifting.
A colleague of ours, a plastic surgeon said years ago that the skin is lift taffy.
The more you pull on it, the more it can stretch and that’s a very meaningful statement.
So in our practice, we actually have a non-surgical approach to skin quality improvement on the
face using a thermal energy device using a laser.
Now this is a laser that is non-ablative.
It is actually heating the deeper tissues of the face as well as in the skin to help
remodel the skin and to improve the quality of the skin.
So a non-surgical approach again is offered there.
I often combine this with platelet-rich plasma which is derived from your own blood to stimulate
your body’s collagen and the blood supply.
The challenge is with aging changes and compounded with sun exposure, the skin gets very thin.
And so it becomes a balance of how much to lift and how much to actually rehabilitate
as well as to improve volume quality in a strategic way.
A lot of times, when we talk about structural volumizing, just going back to that, the point
of doing it in the level we’re doing it is that the skin is now the skin is not a
critical factor.
When fillers are typically used by most doctors, it’s placed within the skin either at the
dermis level, the backbone of the skin, or under the skin.
Unfortunately, the skin can only tolerate so much weight and therefore you can’t get
as much of a correction as you can when you do it at the bone level.
So the photo you submitted showing the lower neck, we might be also dealing with the skin
quality issue and the skin quantity issue.
There are terms for the aging changes of the neck such as Poikiloderma of Civatte or other
changes of fine lines, wrinkling or discolorations, telangiectasias or little blood vessels, just
generalized quality diminishing with aging.
People often want their skin lifted to make things look tight and good because when they
stretch the skin, it looks good.
But unfortunately, there’s a limitation because you have to turn your head and move
around.
So that’s again something that’s more amenable to PRP and laser treatment.
So as far as answering the question, is it safe to do another lift, I would say that
it is typically safe unless there’s any issue with the blood supply, vascularity and
the quality of the skin but I think that you have other options to address the issues that
concern you.
So meet with doctors, maybe meet with the original doctor who performed these procedures
you.
Learn about these other options.
Fillers to add volume, laser or thermal energy devices to improve skin quality and to improve
skin tightening done intelligently and strategically too much of everything is never a good thing.
But doing it in the right amount and the right way can really make an impact.
So I hope that was helpful, I wish you the best of luck and thank you for your question!