Q: Dr. Eppley, I am a plastic surgeon in New Mexico and need your thoughts on a facelift patient that I did six months ago. She is a 65 year-old woman that I did a full facelift on. Despite pulling and getting her as tight as I could, she is now left with some loose residual skin in the neck. She nor I want to go through another facelift procedure and I doubt very highly I could get her neck to get any better by this approach. Do you have any suggestions.
A: For residual loose central neck skin after a facelift, one option is either a submentoplasty or a direct neck lift. A direct necklift is always more effective if she is willing to accept a fine line central enck scar. A good direct necklift option for this lady is what I call the Zipper Necklift. It is just a running w-plasty from the submental crease down to a low horizontal neck crease no lower than the thyroid cartilage. (never go as low as into the sternal notch area) By the pictures you can see it is just a running w-plasty excision/closure. The key is the markings. Halfway between the submental and thyroid cartilage pinch the loose skin together and mark it. That will be the point of the widest arc of excision. Then make a vertical ellipse from top to bottom but make the lines INSIDE your previous pinch mark. Then mark your running w-plasties going to the outside of that mark. Excise full thickness skin and fat right down to the platysma muscle. Then you can sew the platysmal muscle together from submental to thyroid cartilage like never before. Close the skin with 4-0 or 5-0 Vicryls for the dermis and 5-0 or 6-0 nylon for the skin. Ointment or glued on tapes is the only dressing. They will have virtually no pain and very minimal swelling and bruising. This will be the sharpest neck angle that you have ever created! The w-plasty concept is to prevent a straight line scar contracture which is greater in women than men because men do a daily scar treatment….shaving. (microdermabrasion)
There are different variations of the direct necklift and the most common is the ‘candelabra’ pattern which adds horizontal excisions at the submental and thyroid cartilage areas. But given that your lady has already had a facelift, she may only need more central neck tissue excision.
Dr. Barry Eppley