Attributes of the beautiful face include a well-defined transition as the jaw line transitions into the neck line (referred to as the cervico-mental angle). While aging is inevitable, it does not typically proceed uniformly. A number of years may elapse during which time one feels as though he / she looks about the same. Conversely, evidence of relatively rapid age-related changes may unfold over fairly brief periods of time. Regardless of the absolute chronology, predictable changes in the soft tissues of the neck accrue over time:
- Fat may accumulate under the chin (submental adiposity)
- Vertical cords may develop in the front of the neck (platysmal bands, which arise from the gradual separation of the edges of the platysma (“grimace”) muscle
- The jaw line – neck line transition becomes blunted and obscured
In the setting of moderate to advanced facial aging, when one continues to “look older than I feel,” when one seeks to “look as young as I feel,” and when more substantial and permanent degrees of improvement are desired, facelift (rhytidectomy) and necklift surgery emerge as the treatments of choice. However, when more limited degrees of aging become manifest primarily in the neck, an isolated necklift can prove beneficial.
Through a necklift procedure, a number of measures can be taken to restore a more youthful, natural look:
- Restoration of a well-defined jaw line – neck line transition via reduction of excess loose neck skin and suspension of the underlying supportive fascia and platysma muscle
- Reduction of excess fat accumulation under the chin via liposuction
- Reduction of vertical neck cords / platysma bands by reattaching the edges of the platysma muscle to one another
The decision to proceed with a necklift can be difficult. We recognize this and strive to guide you through the decision-making process. Several examples prove illustrative of the many nuances that may bear consideration:
- While one may be principally bothered by age-related changes to the neck, laxity in the facial soft tissues must oftentimes also be addressed to achieve an optimal, natural result in the neck.
- An isolated neck lift can be performed, but only in select circumstances:
- Loss of a well-defined neck line without significant jowling along the jaw line
- Sagging neck skin with preservation of facial skin tone / elasticity
- Prominent vertical neck cords / platysmal bands
- Multiple necklift techniques exist, including myriad variations of traditional techniques as well as newer “minimally invasive” procedures that employ novel technologies. For example, a neck lift can be easily paired with submental liposuction in cases of excess fat accumulation. Our philosophy holds that when a necklift is the proper operation to meet a patient’s goals, there is simply no comparable substitute. We do vary our techniques depending on individual goals and anatomical findings. The point remains that we use techniques that have proven reliable over time.
- People are busy. People lead complex lives within an increasingly complex society. In this context, minimally invasive procedures that offer relatively brief periods of recovery are obviously appealing. Our experience finds that these techniques are valuable when selected after careful review of a given patient’s anatomy, desired esthetic changes and surgical goals.
During the pre-surgical consultation, the rejuvenation goals and desires of each patient are discussed in detail. A detailed examination and analysis of the face and neck is performed. Digital photographs of the face and neck are reviewed on our advanced computerized imaging software to facilitate communication of the changes desired and to illustrate the expected post-surgical outcomes. A comprehensive surgical plan customized to address each patient's concerns is ultimately developed and carefully explained.
Necklift surgery is performed on an out-patient basis under general anesthesia.
Necklift incisions start in the earlobe creases and continue around the earlobe to end behind the ear in the temporal scalp hair. Incisions are thus placed along normal anatomic borders and creases to maximize the ability to camouflage scars. Great care is taken to preserve the hairline position and maintain the pre-operative shape and position of the ear lobe.
Necklifting with or without neck liposuction also oftentimes requires an additional small incision placed in the shadow line underneath the chin. Again, great care is taken to maximally camouflage the scar by hiding it underneath the chin.
Specific techniques commonly used during necklift surgery include:
- Excision of excess loose or sagging skin to improve skin tone
- Re-suspension of the superficial musculoaponeurotic system (SMAS) of fascia to improve soft tissue tone. This strengthens the “fabric” upon which the overlying skin is re-draped and enhances neck line definition
- Reduction of fat underneath the chin (submental adiposity) via liposuction
- Suturing of the neck platysma muscle to reduce vertical neck “bands” or “cords,” improve neck line contour, and improve jaw line – neck line transition
Patients are discharged home on the day of surgery, with close follow-up in the office thereafter. Post-surgical dressings are changed in the office on post-operative day #1. Surgical drains, if placed, are typically removed at this time as well. Incisions are gently cleansed, and care instructions are reviewed. The majority of sutures are removed at 1 week post-operative, with the remainder removed at 2 weeks post-operative. Post-operative bruising is markedly improved by this visit. Post-operative swelling gradually subsides throughout the recovery period. Follow-up office visits are then typically scheduled at the 1 month, 3 month, 6 month, and 1 year post-operative time intervals.
Necklift surgery should ultimately produce a durable result that helps patients look as young as they feel. Discernible, significant improvements in neck skin tone, neck skin contour and jaw line – neck line definition transpire naturally, without appearing excessively “pulled” or “stretched.” After an appropriate amount of time elapses for recovery, patients are expected to look refreshed and rejuvenated without appearing “operated.”