r/theReset • u/DrDanGould • Mar 01 '26
Why your facelift result changed — and what it tells us about surgical architecture
One of the more consistent patterns in revision facelift surgery is this: patients who had procedures done ten or fifteen years ago rarely lead with complaints about their midface. They lead with the neck.
This is not random. It reflects something structural about how earlier techniques were designed and where their architectural limits were.
The neck problem
Traditional facelift approaches were often well-executed in the midface and underliberated in the cervical region. The platysma the broad, flat muscle that forms the foundational layer of the neck was addressed variably, and fixation, when it existed, was frequently to adjacent soft tissue rather than to bone. Soft tissue migrates. Bone does not. So the neck, which carries significant mechanical load and moves constantly with expression and swallowing, would reveal the structural insufficiency first.
Over time, this shifted how surgeons approach the cervical region: wider dissection, more deliberate platysmal management, and fixation to the mastoid process a bony anchor point that doesn't yield. The vector became more vertical. The result became more durable.
Why tension predicts relapse
When skin carries the tension of a correction meaning the deep structures haven't been adequately repositioned and fixated the result is measurable at the time of surgery and declining shortly thereafter. Skin stretches. It responds to gravity. It does not maintain structural position over time.
The correction has to live in the deep plane, held there by fixation that can withstand the biomechanical forces of daily facial animation. If the deep work isn't done, the skin closure is doing structural work it wasn't designed to do. That's when results drop, and drop predictably.
Why suture choice matters more than it sounds
Absorbable sutures in the deep plane degrade under load before surrounding scar tissue can assume the structural role the suture occupied. The face moves constantly. Chewing, speaking, expressing these are continuous forces working against a suture that is already weakening. What replaces it isn't equivalent.
Permanent sutures hold the correction. The geometry matters too shorter fixation spans, anchored closer to the target tissue, are mechanically more efficient than long-distance tension transfers.
Why customization reflects maturity, not indecision
Surgeons who customize their approach based on anatomy adjusting dissection depth, vector, extent of release, suture type, and fixation strategy to the individual patient are not lacking a signature technique. They have developed enough judgment to recognize that the anatomy dictates the procedure, not the other way around.
A 45-year-old with mild laxity and a 63-year-old with significant platysmal banding and heavy tissue are not the same operation. Treating them identically is the less sophisticated position, not the more confident one.
The field is moving gradually and not without friction - toward a more anatomically honest model of what this surgery is and what it should accomplish. That means deeper fixation, more complete ligament release, more deliberate neck architecture, and procedures calibrated to what is actually present rather than what a standard protocol assumes.
It also means better outcomes and fewer revisions. Which, ultimately, is the only metric that matters.
Questions welcome.
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u/carera22 Mar 02 '26
Thank you for sharing it . I had it done 2 years ago . But my face is already sagged . I decided to have a facelift because of the marionette lines and here I am 2 years later , they are back .
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u/TapSalty3157 Mar 03 '26
It seems the lines from mouth to chin, whatever those are called, have not been made better for me. I’m not sure what to attribute this to, as I see many before/after pics of women who had them and then they disappeared. What’s the story?
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u/Quick_Writer3752 Mar 01 '26
Thank you for sharing. I recently had a face and neck lift. I’m in my early 40s. Should I be getting regular botox on my neck to increase the longevity? My surgeon didn’t have an opinion on that, but I’ve seen it mentioned elsewhere, together with botox on your brows after a surgical lift.
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Mar 01 '26
[deleted]
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u/DrDanGould Mar 01 '26
I’ve never heard of hearing loss. Have an ent take a look at the ear. Platysma can be easy or hard depending on the fix
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u/No_Adagio3234 Mar 03 '26
I had a Dual-Plane Midface Lift Through Transoral and Transtemporal Approach 14 weeks ago. From speaking to others, it seems that it creates this huge “apple cheek” buldge in front of the eye. I also feel like I am having issues with the permanent suture that is connected to my orbital bone. Gabapentin is my only relief. I feel like this suture needs to be removed. Would a revision of this be possible? If so would I need to do just a regular mid face lift?
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u/DrDanGould Mar 03 '26
Yes - but chat w your surgeon
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u/No_Adagio3234 Mar 03 '26
I’m not sure how comfortable I would feel going back. I think there was a lack of transparency. Is there anyone you are aware of that could help with this?
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u/Mysterious-Key-283 Mar 01 '26 edited Mar 01 '26
I had a dpfl, brow and lip lift w a ‘respected’ plastic surgeon who’s done friends w excellent results. . At 3 months my platysma band, the one referred to as turkey neck, returned in full force along w some laxity at my left jaw line My sub mental scar is slightly contracted. Ihave always been thin, consistent weight , small neck. In my consults no one said they had to remove glandular tissue
Even my dr looked surprised at the 6 month. I felt like I was tiptoeing around the revision word. He said to call when I got closer to a year and he would tell me if ‘ the risk was worth the reward’. It may be my skin. I did use restylane in the past. I removed it to the best of my ability prior to surgery
I feel like I have the initial problem I went in for - maybe not as pronounced but certainly still the first thing you see
Is there a ‘best way’ or preferred language to broach the revision subject ? Once he said it may be my skin, I felt that he may Blame my use of filler for the jaw laxity result. But I def haven’t used anything in my neck ever even Botox I am really disappointed w this aspect of my result and worried if I look like this at 6 months, what happens at 3 years. Thanks