How Can I Get Rid Of These Neck Bands That Have Developed After My Facelift?

Q: Dr. Eppley, I had a facelift with lipo done two years ago. While the result has overall been very good, I am unhappy with the appearance of my neck under the chin area. I’ve included a few photos so you can get a better idea of my situation. When I don’t lift my chin or move my head things look good, but moving my head or chin around creates a really unattractive situation that distracts from the very nicely done lower facelift. I am thinking these are muscle bands that need to be swen together to fix it. What do you think?

A: In looking at your pictures, I don’t think that the vertical bands you are seeing in your neck are platysmal muscle edges. Notice that there are numerous ones not just two isolated long parasagittal bands. I think what you have is a ‘skeletonization’ effect.  This means the there is very little neck fat between the skin and the muscle which can lead to adhesions and scar contractures in the neck which are vertical in orientation and almost always occur primarily in the submental area. They are most evident when the chin is raised and the neck stretched upward. This is prone to occur in thin women when the neck is aggressively liposuctioned as part of the submental management of their facelift. There always needs to be some fat left on the skin otherwise adhesions will result. The question then becomes as to how to manage that issue as further muscle plication may not be the ultimate answer. In my experience, re-elevation of the involved skin (adhesion release) and possible muscle plication if needed is the best approach. In an ideal world, some fat would be put back or a dermal graft placed as an interface between the skin and the muscle but I would go with the simpler skin flap elevation/adhesion release initially.

Dr. Barry Eppley

Indianapolis, Indiana