What is this procedure?
A neck lift or ‘platysmaplasty’ is often preferred over a face lift (rhytidectomy), although it can be performed at the same time. This is surgery undertaken to correct loose skin around the neck and jawline. It is also known as a platysmaplasty or a ‘cervicoplasty’ and can be carried out at the same time as a rhytidectomy (face lift).The neck is one of those places on the body which clearly shows the effects of the ageing process and one way of dealing with this is to undergo a neck lift. This tightens and firms loose skin around the neck which gives a clearly defined jaw line and a youthful appearance.
Who needs this procedure?
The ageing process and gravity cause the skin of the neck and jawline to lose elasticity and tone. This manifests itself as ‘age bands’ around the neck and loose folds of skin and fat around the jaw bone. If you have noticeable ‘jowls’ then consider this procedure. If you have recently lost a great deal of weight, either by dieting or from weight loss surgery then you may have sagging folds around your neck and jaw. Your surgeon will be able to decide whether you are suitable for neck lift surgery. He or she will take various factors into account which include your age, current weight, general health and motivations for surgery. The minimum age for this surgery is 18 although exceptions can be made for those aged 16 or 17. Even though a neck lift is associated with older people due to the ageing process it can be a good procedure for young patients if they have lost vast amounts of weight. Surgeons prefer younger patients to have reached their full growth and in the case of girls, started their periods before considering this procedure, Excess fat and skin relaxation in the lower face that creates jowls, Excess fatty deposits under the chin, Loose neck skin, Muscle banding in the neck, which created abnormal contours.The loss of youthful contours in the face and neck can be due to a variety of factors, including heredity,gravity, environmental conditions and stress.Some people feel they are not ready for a full facelift because the upper face is still pleasing. However, many patients will note excess wrinkling of the neck skin, a double chin or “turkey wattle” and jowl lines. When the neck area doesn’t match the upper facial appearance, a neck lift may be a good solution. Rejuvenation procedures that can be performed in conjunction with a neck lift are: a brow lift, to correct a sagging or deeply furrowed brow, fat transfer, to add fullness to the lips and cheeks and reduce the appearance of wrinkles, or eyelid surgery, to rejuvenate aging eyes. As a restorative surgery, a neck lift does not change your fundamental appearance and cannot stop the aging process. A neck lift can only be performed surgically; nonsurgical rejuvenation treatments cannot achieve the same results, but may help delay the time at which a neck lift becomes appropriate and complement the results of surgery.
What is the advantage of this procedure?
The delicate skin of the neck is particularly vulnerable to the effects of aging, heredity, and environmental influence, and this highly visible area can often prove immune to the typical benefits of diet and exercise. As a result, many patients experience skin laxity, deep creases, softening muscles, and the development of fatty deposits on the neck and jawline over time. Some individuals may also have neck cording, also called platysmal bands, which stretch from the chin and jaw down to the bottom of the neck. There are a multitude of benefits to neck lift surgery from our practice. In addition to creating a more refined facial contour, neck lift surgery can:Reduce excess skin, Minimize the appearance of fine lines and wrinkles,Tighten underlying muscles, Diminish the appearance of platysmal bands, Contour the chin and jawline. In some instances, patients may benefit from facial liposuction in addition to neck lift surgery to help remove pockets of fat and produce a more youthful shapeliness to the lower face. Furthermore,many individuals opt to combine a neck lift with additional cosmetic enhancements, such as a facelift, brow lift, or dermal fillers such as Restylane® or JUVÉDERM®or fat grafting for more comprehensive rejuvenation.
Are there non-surgical treatments?
As we age, the collagen that keeps our skin firm breaks down resulting in aging skin that contains fine lines and wrinkles. A Thermage FLX treatment uses radiofrequency technology to heat the deeper, collagen-rich layers of the skin.The applied heat causes collagen to contract and encourages new collagen to start growing. This helps create smoother skin after just one treatment with results that continue to improve.
What is the surgical treatment like local or sedation?
Neck Lifts have been traditionally performed by plastic surgeons while making you going to sleep (general anesthesia or IV sedation) to prevent the pain associated with the surgical procedure. Although these types of modalities are relatively safe, they are still associated with certain risk that could sometimes be life threatening (e.g. losing airway, arrhythmias, etc.). Patients that would like to avoid these risks, usually refrain from cosmetic plastic surgery of the neck, thus finding them unable to refresh themselves and look their best with cosmetic surgery of the face and neck. A Neck Lift under local anesthesia is a surgical procedure that provides patients with a rejuvenated, refreshed and natural look without an “operated look’ stigmata. Neck Lift under local anesthesia has the significant advantage of being performed while the patient is awake using a local anesthesia to numb the entire neck and make the procedure comfortable. Therefore, there’s no need of general anesthesia (going to sleep) or IV sedation (twilight anesthesia), avoiding the risks associated with them. Being awake allows the patient to breathe by her or himself (no need for breathing tube and anesthesia machine). It also allows the patient to keep her/his blood pressure stable throughout the operation, which increases the safety and healing process. Very often the patient will have a collegial conversation during the procedure making the experience an incredible one. By maintaining the blood pressure stable during the procedure under local anesthesia, the there’s also far less bruising,swelling, hematoma formation (acute accumulation of blood under the skin) and downtime for Neck Lift under local anesthesia.
What is the recovery like?
Recovery time after a neck lift will depend on the individual, as well as the extent of surgery. Typically, patients return to daily activities, including a return to work, within 2 weeks after surgery. Expect your neck to feel tight for a few weeks, and know that bruising and swelling are normal. While it can take anywhere from 2-4 weeks to recover from a neck lift, most people find that they are “presentable” by 2 weeks. At Soma Plastics we recommend patients to take 2 weeks off from work following a neck lift so that most of the swelling and bruising has resolved. Most patients are allowed to return to their normal activities, particularly regular exercise, at 3-4 weeks following surgery.
How long does it take?
A neck lift can take around two hours to complete, under a general anesthetic. If it is performed along with a face lift then this time will increase. It means an overnight stay in an aftercare or a hospital might be required. Your surgeon will make small incisions underneath your chin or behind your ears. He or she will move and tighten loose folds of skin around the jaw and neck. Once he/she has done so he/she will secure this newly tightened skin with stitches or tissue glue. There are two techniques with this – platysmaplasty which corrects the neck muscles and cervicoplasty which firms and tightens loose skin. Liposuction can be used in combination with this to help remove any excess fat. In order to reduce any scarring, your surgeon may use endoscopic or keyhole techniques.
A neck lift procedure includes the following steps:
- Step 1 – Anesthesia Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. Your doctor will recommend the best choice for you.
- Step 2 – The incision Depending on the degree of change you’d like to see, your neck lift choices include a traditional neck lift incision or a limited incision neck lift. A traditional neck lift incision often begins in the hairline at the level of the sideburn, continues down and around the ear and ends in the posterior hair. Fat may be sculpted or redistributed from the jowls and neck. The tissue underlying the neck skin is repositioned, and commonly the platysma muscle is tightened. Skin is draped over the uplifted contours and excess skin is trimmed away. A separate incision under the chin is often necessary for liposuction of this area and for repair of the muscle. Sutures or skin adhesives close the incisions. A limited incision neck lift may involve incisions only around the ear. While the incisions are shorter, the results may be more limited.
- Step 3 – Closing the incisions Incision lines are closed with sutures and perhaps skin glue. Sutures may be dissolving, or may need to be removed after a few days. Once healed, the incision lines from a neck lift are usually well concealed within the hairline and in the natural contours of the ear.
- Step 4 – See the results The visible improvements of a neck lift appear as swelling and bruising subside. Your final neck lift result should not only restore a more youthful and rested appearance, but also help you feel more confident about yourself.
How long has it been around?
In the first 70 years of the 20th century facelifts were performed by pulling on the skin on the face and cutting the loose parts off. The first facelift was reportedly performed by Eugen Holländer in 1901 in Berlin. An elderly Polish female aristocrat asked him to: “lift her cheeks and corners of the mouth”. After much debate he finally proceeded to excise an elliptical piece of skin around the ears.In the First World War (1914–1918) the Dutch surgeon Johannes Esser made one of the most famous discoveries in the field of plastic surgery to date, namely the “skin graft inlay technique,” the technique was soon used on both English and German sides in the war. At the same time the British plastic surgeon Harold Delfs Gillies used the Esser-graft to school all those who flocked towards him who wanted to study under him. That’s how he earned the name “Father of 20th Century Plastic Surgery”. In 1919 Dr. Passot was known to publish one of the first papers on face-lifting, this consisted mainly on the elevating and redraping of the facial skin. After this many others began to write papers on face-lifting in the 1920s. From then the esthetic surgery was being performed on a large scale, from the basis of the reconstructive surgery. The first female plastic surgeon, Suzanne Noël, played a large role in its development and she wrote one of the first books about esthetic surgery named Chirurgie Esthetique, son role social. In 1968 Tord Skoog introduced the concept of subfacial dissection, therefore providing suspension of the stronger deeper layer rather than relying on skin tension to achieve his facelift (he publishes his technique in 1974, with subfacial dissection of the platysma without detaching the skin in a posterior direction). In 1976 Mitz and Peyronie described the anatomical Superficial Musculoaponeurotic System, or SMAS, a term coined by Paul Tessier, Mitz and Peyronie’s tutor in craniofacial surgery, after he had become familiar with Skoog’s technique. After Skoog died of a heart attack, the superficial muscular aponeurotic system (SMAS) concept rapidly emerged to become the standard face-lifting technique, which was the first innovative change in facelift surgery in over 50 years. Tessier, who had his background in craniofacial surgery, made the step to a subperiosteal dissection via a coronal incision. In 1979, Tessier demonstrated that the subperiosteal undermining of the superior and lateral orbital rims allowed the elevation of the soft tissue and eyebrows with better results than the classic face-lifting. The objective was to elevate the soft tissue over the underlying skeleton to re-establish the patient’s youthful appearance. At the start of this period in the history of the facelift there was a change in conceptual thinking, surgeons started to care more about minimizing scars, restoring the subcutaneous volume that was lost during the ageing process and they started making use of a cranial direction of the “lift” instead of posterior. The technique for performing a facelift went from simply pulling on the skin and sewing it back to aggressive SMAS and deep plane surgeries to a more refined facelift where variable options are considered to have an aesthetically good and a more long-lasting effect.
What are the complications?
The decision to have a neck lift is extremely personal. You will have to decide if the benefits will achieve your goals, and if the risks and potential complications of a neck lift are acceptable.
You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.
Neck lift surgery risks include:
- Anesthesia risks
- Temporary or permanent hair loss along the incisions
- Facial asymmetry
- Rare nerve injury that could cause weakness of the lower lip
- Fluid accumulation (hematoma)
- Unfavorable scarring
- Prolonged swelling
- Skin irregularities and discoloration
- Skin loss
- Sutures may spontaneously surface through the skin, become visible or produce irritation and require
- Numbness or other changes in skin sensation
- Persistent pain
- Poor wound healing
- Rare risk of deep venous thrombosis with cardiac or pulmonary sequelae
- Unsatisfactory results which may require revisional surgery
What can you do to speed up recovery?
During your recovery from neck lift surgery, a bandage could gently be placed around your face and neck to minimize swelling and bruising when your procedure is completed. A thin tube may be present to drain any excess blood or fluid that may collect under the skin. You will be given specific instructions that may include how to care for the surgical site and drains, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your general health and when to follow up with your plastic surgeon. It is important to keep your head elevated above your heart to minimize swelling and to keep your head straight (no excessive twisting or bending of the neck). DO NOT APPLY ICE to the neck as this can compromise blood flow and result in skin death.
Be sure to ask your neck lift surgeon specific questions about what you can expect during your individual recovery period:
- Where will I be taken after my surgery is complete?
- What medication will I be given or prescribed after surgery?
- Will I have dressings/bandages after surgery?
- When will they be removed?
- Are stitches removed? When?
- When is it safe for me to drive?
- When can I resume normal activity and exercise?
- When do I return for follow-up care?
Do you need to rest up afterwards and for how many days?
Your neck will feel bruised, sore and swollen and you may have to wear a special compression bandage afterwards. This will have to be worn for a week following surgery. If not then you will have a light dressing in place which must be kept clean and dry for two weeks. After these two weeks your dressing will be removed in order to examine and clean the wounds.You will have been given pain relief to control any discomfort.There will be scarring although these will be very small and will fade over time. Please keep these incisions clean avoid soaking them in water until they have fully healed. Your surgeon will give you advice on this and other post-surgery aspects. Make sure you rest and take things easy once back at home. Do not overtire or strain yourself. It is a good idea to keep your neck in an elevated position for the first couple of days.You will require a week (or two) off work and avoid any strenuous activities during this time. It will be a month before you can return to the gym or undertake any exercise.If you notice any of the following then contact your surgeon: bleeding, sudden, intense pain, infection,irregular heartbeat, shortness of breath or chest pains. Afterward, your neck may feel tight, and you may notice some bruising, which fades in a couple of weeks.Sutures (stitches) can come out in five to 10 days.Recovery from a neck lift takes several weeks. Following your surgeon’s post-surgery instructions is very important. You will receive details on addressing swelling and bruising and managing any discomfort.The instructions will also advise you when to resume your regular activities and when to call the office in case of any unexpected changes or problems.