Neck Lift After Nonsurgical Treatments: Fibrosis, Fat Loss, and Surgical Complexity

Abstract Background Noninvasive neck treatments, including lipolysis injectables, cryolipolysis, and energy-based devices, have become popular alternatives to surgery. Although marketed as safe and effective, these procedures may induce fibrosis, tissue destruction, and anatomical changes that complicate secondary surgical interventions. Objectives In this study we aimed to assess the impact of previous noninvasive neck treatments on surgical complexity, intraoperative findings, and outcomes in secondary neck lift procedures. Methods A retrospective review of 180 neck lift procedures performed in 2023 by a single surgeon was conducted. Patient demographics, previous treatments, intraoperative findings, and postoperative outcomes were analyzed. Results Of 180 patients, 123 (68%) had had previous neck treatments, including surgical neck lift and/or noninvasive therapies including chemolipolysis (Kybella), cryolipolysis (CoolSculpting), radiofrequency-assisted lipolysis (FaceTite, Morpheus8, SmartLipo, Ultherapy, Profound), and suture suspension (MyEllevate, PDO threads). Intraoperative findings in patients having undergone nonsurgical treatments revealed fibrosis, loss of normal tissue planes, platysma and deep fascia rigidity, and unpredictable fat distribution. A deep cervicoplasty with management of subplatysmal structures was required in 94% of the cases. Although no major complications occurred, nearly all patients exhibited contour irregularities postoperatively from the destruction of the supraplatysmal fat and platysma. In all cases there was an increased operative time. Conclusions Noninvasive neck treatments significantly alter tissue architecture, increasing surgical complexity and impacting aesthetic outcomes. Surgeons should anticipate these challenges, modify techniques accordingly, and emphasize thorough preoperative evaluation and patient counseling to anticipate increased risk and optimize results. Level of Evidence: 4