Neck Lift Surgery
A neck lift procedure aims to rejuvenate the neck and restore a youthful contour. Droopy skin, fat and muscle in the neck is unfortunately a common problem and is one of the earliest signs of aging for many people. Aging of the face, eyelids and brow often becomes more noticeable some years after the neck. Excess neck tissues can appear quite suddenly. A period of weight gain or loss may precede their development.
As we age, the area under our chins can develop excess fat, sagging skin, muscle or a combination of these. This can give the appearance of weight gain even if you have not actually gained any weight. Sometimes these changes in the neck are referred to as a “turkey neck”.
Requests to rejuvenate the aging neck are common in both men and women. People are often deeply embarrassed by their ageing neck changes, more so than their face. Friends and colleagues may not be similarly affected and patients’ often describe feelings of self-consciousness.
Often the redundancy of the neck tissues is also seen in the face. In many patients the excess tissue in the neck was originally located up in the face and has fallen slowly over many years below the jawline into the neck. Sun exposure, genetic factors as well as significant changes in weight can accelerate this process.
The best way to rejuvenate the neck is through a neck lift procedure. In this procedure redundant skin, muscle and fat is contoured and repositioned back where it should have been in earlier years. Sutures are used to suspend the tissue back up around the ears.
Sometimes a small incision is necessary under the chin where the hanging edges of the platysma muscle are stitched together. Further small incisions hidden around the ear and hairline then allow the neck tissues to be lifted and tightened. The end result is usually a very smooth, tight jawline and neck.
A neck lift can be combined with a facelift to include rejuvenation of the midface and upper face. It can also be performed without including these upper areas. The incisions (scars) for a neck lift are in a very similar location to a facelift so these two procedures are very often performed together. The best necklift results are obtained through a deep plane facelift which includes a necklift.
The best necklift results are obtained when there is full release of the retaining ligaments of the neck and face. Once these are released, the neck and facial tissues can be gently repositioned with no tension leading to natural, long lasting results. Three important retaining ligament groups are the cervical, mandibular and zygomatic.
The neck can be a challenging area to treat with more old fashioned surgical techniques such as the “skin only” neck lift and SMAS and MACS facelifts. Injectables (botox, fillers) are often not very helpful in the neck with only very temporary results and best utilised in younger patients with only mild changes of ageing.
Dr Roth specialises in the vertical neck lift technique (also known as the vertical platysmal advancement technique) as popularised by Dr Andrew Jacono and Dr Neil Gordon in the USA. The vertical neck lift is an extended deep plane facelift that elevates the skin and SMAS-platysma complex as one unit. It provides beautiful, natural and long-lasting results. Laxity in the neck is dealt with by repositioning tissues to their natural position in the face and jawline.
The vertical neck lift technique does not routinely require midline platysmal surgery (a platysmaplasty) because it counteracts the effects of gravity and ageing by vertical movement of tissues. It is powerful when needed and can tackle even the most challenging necks with good results.
A number of adjunctive procedures may be necessary at the time of a necklift, depending on patient anatomy. These include removal of excess skin, liposuction, a platysmaplasty, reduction in the size of the digastric muscles, submandibular gland suspension, a chin implant.
Loose skin removal
Loose neck skin tends to wrinkle and sag. The platysma muscle (which is often very prominent in younger patients) tends to thin out leaving redundant overlying skin.
Generally some skin is removed with any necklift procedure apart from in the youngest patients. The actual amount removed varies between patients depending on their anatomy. Skin incisions are designed to optimise loose skin removal and hide scars.
Liposuction removes fat cells through a small suction device. 3 tiny “ports” or cuts in the skin are required to insert the device used to remove the fat. Liposuction only removes fat and does not address excess skin or platysma muscle that may be redundant in the neck. It can be a useful adjunct when recontouring the neck with a necklift procedure. Occasionally it is performed in isolation without other procedures. Neck liposuction needs to be done conservatively to avoid an “overdone” look as well as scarring.
This procedure focuses on the platysma muscle that sits just underneath the skin’s surface at the front of the neck. Over time, this muscle can create significant vertical bands in the neck, adding to an aged appearance.
Caption: There are a number of variations in platysma anatomy
When the two edges near the midline hang with a hollow area in between, this can be called a “cobra neck”.
A platysmaplasty is a surgical procedure that stitches the edges of the muscle together and can create a smoother neck surface. A small incision is made under the neck which allows the two edges to be sutured together in the midline. Once the muscle has been stitched together, it can be lifted by other small incisions located near the ear to eliminate the bands completely.
In the majority of patients who undergo a vertical neck lift which includes a deep plane facelift and necklift, a platysmaplasty is not necessary as the lift procedure will eliminate all redundant platysma. Whether or not a platysmaplasty is needed can be determined at the time of a pre-operation consultation. The essential test is whether the neck redundancy is completely eliminated when the face is lifted from the sides. If that is the case, a platysmaplasty is not needed.
Digastric muscle reduction
Fullness under the chin can often been partially caused by a low hanging belly of the digastric muscle. This is particularly the case in individuals who are born with a hyoid bone that sits low in the neck. The digastric muscle attaches to the hyoid bone. The anterior belly of the digastric muscle can be partially reduced in size to improve the contour of the upper neck.
Submandibular gland suspension
The submandibular glands tend to droop down into the neck with age. This can lead to a bulge in the upper neck about halfway along the jawline. It is important to support and elevate the submandibular glands as part of a necklift procedure.
Dr Roth uses a technique whereby the platysma muscle is tightened like a hammock under the submandibular gland to effectively tuck it upwards under the jawline.
A recessed chin can impair a good neck lift result. A chin implant can be inserted at the same time as necklift surgery for a better result if needed.
Submental fat removal
If prominent, fat under the chin may need to be removed directly. This can be done with scissors or liposuction. The fat can be located over the top of the platysma muscle, between the muscles in the midline or underneath the muscle.
Dr Jason Roth is a specialist ENT and Head & Neck Surgeon who is trained to perform neck lift and facelift procedures safely and effectively. He has trained with Dr Neil Gordon, one of the leading facelift and neck lift specialists in the United States. He has also been certified with the International Board Certification in Facial Plastic Surgery.
Neck Lift Before and After Patient 1
Neck Lift Before and After Patient 2
A deep plane facelift, necklift, upper and lower blepharoplasties, browlift and tonsillectomy were performed.
Neck Lift Before and After Patient 3
She underwent a deep plane facelift, neck lift, browlift, lower eyelid blepharoplasties and a perioral skin peel. Photos taken 6 weeks after surgery show a significant improvement.
Neck Lift Before and After Patient 4
Neck Lift Before and After Patient 5
The patient underwent a deep plane facelift, necklift, upper eyelid blepharoplasties, browlift and perioral TCA skin peel.