Dr. T. Gerald O’Daniel: Neck Lift After Nonsurgical Treatments: Fibrosis, Fat Loss, and Surgical Complexity

Dr. T. Gerald O'Daniel's study shows nonsurgical neck treatments like Kybella and CoolSculpting cause fibrosis, fat loss, and neck lift surgery complexities.

LOUISVILLE, KY, UNITED STATES, October 2, 2025 /EINPresswire.com/ -- A new study published in the Aesthetic Surgery Journal by Dr. T. Gerald O’Daniel (MD, FACS, MBA) and colleague Sarah Patton, BS, from the University of Louisville, titled “Neck Lift After Nonsurgical Treatments: Fibrosis, Fat Loss, and Surgical Complexity,” reveals how prior nonsurgical treatments affect surgical complexity, intraoperative challenges, and postoperative outcomes in secondary neck lift procedures. These findings help surgeons anticipate complications and improve patient care. The article is available at https://doi.org/10.1093/asj/sjaf149.

The research analyzed 180 neck lift procedures performed in 2023 by Dr. O’Daniel. Variables included patient demographics, history of nonsurgical treatments, intraoperative observations, and outcomes. Over two-thirds of patients had undergone prior treatments such as energy devices, Kybella, CoolSculpting, and thread lifts. Each treatment type showed destructive features as well as unique surgical findings.

Many patients present with concerns beyond skin laxity. “The true issues are often imbalances between superficial soft tissue and deep neck structures,” explained Dr. O’Daniel. While nonsurgical procedures typically target supraplatysma fat and subcutaneous tissue, “They do not address the deeper structures or muscles that contribute to an unaesthetic neck appearance.”

Minimally invasive techniques may temporarily tighten superficial fascia but often create deformities by targeting the wrong tissues. “Noninvasive options, often marketed as surgical alternatives, have shown inconsistent results, even in ideal candidates,” said Dr. O’Daniel. Treatments such as FaceTite, Morpheus, SmartLipo, Ultherapy, Kybella, and CoolSculpting frequently compromise outcomes or create contour irregularities.

Major findings include:

• Finding #1: Patients with a history of nonsurgical treatments demonstrated fibrosis, loss of normal tissue planes, rigidity of the platysma and deep fascia, and unpredictable fat distribution.
• Finding #2: A deep neck lift addressing subplatysma structures, including submandibular gland reduction, was required in 94% of cases.
• Finding #3: While no major complications occurred, nearly all patients developed postoperative contour irregularities due to supraplatysma fat and platysma destruction, adding operative time in these cases.

“The public is unaware of the damage being done by these nonsurgical devices. My goal is to spread awareness to the general public and fellow plastic surgeons by sharing my findings. Patients should research treatments before receiving them to understand risks. Providers should carefully review technology before bringing these devices into practice,” said Dr. O’Daniel.

Clinical implications for surgeons:
Nonsurgical treatments alter tissue architecture, complicating surgical correction and affecting aesthetic outcomes. Surgeons should adjust their approach, conduct thorough preoperative evaluations, and counsel patients on realistic expectations and increased risks.

Study limitations include:
• The study reflects the referral population of the senior author, whose practice often receives patients with complications or unsatisfactory outcomes after prior treatments.
• As a retrospective review, findings are limited to perioperative observations and exclude histologic or pathologic evaluation.
• Standardized outcome measures were not available, and no comparisons were made with patients who had favorable nonsurgical results.

Implications for patients:
Delivering heat through radiofrequency to facial and neck tissues fuses tissue layers together and creates deformities instead of ideal results. With aging, some fat beneath the skin is needed to prevent atrophy and maintain a youthful look. Once damaged, these layers cannot be restored. Even with a deep neck lift, destroyed tissues lead to suboptimal outcomes.

Patients should understand how each treatment works, which tissues are targeted, and that subcutaneous fat—most often affected—contributes little to poor contour or loose skin. This fat naturally thins with age. Most importantly, anyone considering a neck lift after nonsurgical treatment must inform their surgeon, as these treatments profoundly affect surgery and outcomes.

About Dr. O’Daniel and O’Daniel Studios

Dr. T. Gerald O’Daniel is a dual board-certified plastic and facial plastic surgeon, and board-certified in otolaryngology–head and neck surgery, in Louisville, Kentucky, with over three decades of experience. He completed advanced fellowship training in facial nerve surgery, craniofacial surgery, and pediatric plastic surgery. Internationally recognized for his work in deep plane facelifts and subplatysmal neck lifts, Dr. O’Daniel combines artistry with surgical science to achieve natural results. He has performed thousands of procedures, published extensively, and regularly teaches surgeons worldwide.

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