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Procedure: Neck Lift

Author: Patrick Byrne, MD FACS

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Neck Lift

Neck Lift

A face lift is a procedure that lifts the sagging skin and soft tissues of the lower face and neck. As such, patients who undergo face lifting nearly always also get a neck lift at the same time. Please see the face lifting content of the Discovery Beauty site for more information on face lifting. However, there are occasions in which it is the desire of the patient to have only the neck lifted.  This article will review the isolated neck lift – a less commonly performed procedure, but an important and effective one.

 

The Problem

Rejuvenating the neck can range from a fairly straightforward procedure with very high success rates, to a difficult and complicated procedure with high rates of revision. A successful result often depends on the anatomy of the patient.  People with favorable anatomy can be rejuvenated beautifully with standard, even minimally invasive techniques. Those with unfavorable anatomy, and heavy necks, will require extensive surgery in order to obtain moderate improvement.

 

Relevant Anatomy

The appearance of the neckline is determined by the bony structures, the relationship of the jaw to the neck and structures of the voice box.  It is also determined by the elastic quality of the neck skin and the amount of excess skin, fat, and muscle.

 

In the most attractive necks, the angle created by the undersurface of the jaw (mandible) and the front of the neck is approximately 90 degrees. This occurs when the small bone that sits atop the voice box, the hyoid bone, is positioned high and back. Ideally the jaw is positioned forward as well. In this scenario, the neck can look very defined.

 

However, if the jaw is poorly projected and the hyoid sits low and forward, then even if the soft tissue of the neck is thin and the skin does not sag excessively, the overall appearance of the neck will still not look elegant and defined.  Therefore, the potential for improvement after a neck lift is limited. All is not lost in such cases because the surgeon can augment the chin, remove fat and tighten the muscles to improve the appearance.

 

On the other hand, if the hyoid position is favorable and the primary problem is excess fat, and/or loose sagging skin, then the potential improvement is dramatic.  The following is a list of the features of the neck that the surgeon will evaluate in developing an individualized treatment plan.

 

  • Chin projection. If the chin is small and recessed, then augmenting this by adding a chin implant might be a good choice to improve the appearance of the neckline

  • Sagging excess skin. In the vast majority of cases the skin will need to be redraped and the excess will need to be removed.

  • “Turkey Bands”.  These vertical bands located under the chin and upper neck are actually the front edges of the thin, sheets of muscle called the platysma. One sheet of muscle is present on each side of the neck. When we are younger, the muscles are joined together in the middle of the neck. As we age, they separate and fall forward. When vertical banding is present, then a procedure is performed to suture them together in order to tighten and correct the banding.

  • Fat excess.  If there is excess fat, then the surgeon will decide how much to remove and from what location. The surgeon will often remove the fat with liposuction, directly with scissors or using both techniques.

  • Deeper muscle anatomy. Some patients have fullness underneath the chin that is due to the deeper muscles of the neck and the floor of the mouth. A portion of these muscles may need to be removed as well.

  • Salivary glands. Some people have bulges in their neck that are from protruding submandibular salivary glands. This may or may not be addressed with the operation. (most surgeons will not).

 

How is the Procedure Performed?

 

Anesthesia

Most surgeons perform neck lifts under either general anesthesia (completely asleep) or using local anesthesia with some level of sedation (conscious and breathing on his/her own). The operation can take anywhere from an hour or two for an isolated lifting procedures, to 6 hours or more when additional operations (e.g. eyelid, brow surgery), are added.

 

Incisions

The incisions for neck lifting are located in front of and behind the ear lobe and under the chin. When the neck lift is performed with face lift the incisions are included with the face lift incisions. Often, the surgeon will perform some tightening of the thin sheet like muscles of the neck through the incision underneath the chin. This allows your surgeon to tighten these bands of muscles together, and also provides another access point to remove excess fat from the neck. This is done either with liposuction, or by direct excision of fat.

 

What is Done Underneath the Skin?

The skin of the neck is elevated – that is, lifted up off the underlying muscle and fat.  If there is excess fat to be removed, this is done with either liposuction prior to lifting the skin, or by directly removing the fat with scissors. Next, the muscle is tightened by using a “corset” suturing technique to bring the edges of the platysma muscle together. The same muscles may also be lifted back, and sutured to the tissue behind the ears.

 

Surgeons manage the skin differently. Many will choose to lift the skin and remove the excess. Some simply lift the skin, “redrape” it and count on the healing process to tighten it. There are theoretical advantages of this approach, including minimizing any poor healing of the incisions, and keeping the incisions shorter.

 

Drains may be placed underneath the skin at the end of the case to allow any fluid that collects to be removed overnight. These are typically removed the next day.

 

What is the Recovery Time?

There is quite a bit of variation in this, depending on how extensive of a procedure is performed, if additional procedures are done at the same time, and even the tendency of any particular patient to bruise. In general, there is quite a bit of swelling and bruising that is maximal during the first week. Most patients will take about three weeks for the majority of the bruising and swelling to resolve. By that time, most will feel comfortable in public, and look really quite presentable. Additional healing continues for several months.

 

What are the Risks?

Every surgical procedure has certain risks. Fortunately, the percentage of patients who have surgical complications is low. The most common complication is a hematoma. This is a collection of blood underneath the surface of the skin. It occurs in about 5% of cases. Another complication is damage to the facial nerve – this could result in weakness of the face (facial paralysis) in one or more areas. It is rare – less than one percent of cases will have long-term facial nerve injury. Temporary facial nerve weakness is a bit more common. Other potential complications include visible scarring, infection, hair loss, and skin necrosis (skin not surviving, and healing by scarring). These are rare.  Another consideration is the risk that you will not be satisfied, and will desire a revision procedure. For people with a lot of loose skin, or a heavy neck, it is important to have realistic expectations with regard to the extent of improvement.

 

Summary

Neck lifting is a very common procedure that is typically done in conjunction with a face lift. There are some people who only need (or want) their neck treated and not the lower face. In these cases, the patient’s anatomy plays a very important role in determining the type and extent of the procedure chosen. The experience and skill of the surgeon is the other important factor that will ultimately determine how successful the procedure will be.

 

References

  1. Discussion: a 26 year experience with vest-over-pants platysmarrhaphy. Feldman J. Plastic Reconstr Surg. 2010 Sep; 126(3):1035-6.

  2. Platysma suspension and platysmaplasty during neck lift” anatomical study and analysis of 30 cases.  Labbe D, Franco RG, Ncolas J. Plastic Reconstr Surg. 2006 May;117(6):2001-7

  3. Rejuvenation of the aging neck: current principles, techniques, and newer modifications. Caplin D, Perlyn C. Facial Plastic Surg Clinics. 2009;17(4):589-601