Neck Lift Surgery

There are many types of neck lift procedures including:

1. Neck liposuction
2. Direct neck lift
3. Deep neck Lift with lateral neck lift (Lower Facelift)

For patients with mild laxity in their neck, an intact platysmal sling, but excess fat starting to decrease definition in the neck, neck liposuction may be all that is needed.

Neck liposuction involves injecting the neck tissues with a tumescent solution.  The tumescent solution provides anesthesia as well as hemostasis to stop bleeding.  Once the tumescent solution has been injected and approximately 20 minutes have elapsed, the neck tissues can be liposuction.  A 2 mm blunt tip cannula is used under mild suction to suction out the fat.  Liposuction works initially by suctioning the fat.  Long term, the cannula moving back and forth across the deep tissues of the neck causes a proliferation of scar tissue.  This scar tightens the neck and enhances the definition and contour of the neck.

Neck Liposuction works well in:

1. Young patients with good contractility of skin and deep neck tissues
2. Mild amount of herniated fat
3. None to minimal sagging skin

Patients with more extensive aging in the neck will need additional surgery to redrape excess skin, and redundant platysma muscle.

The direct neck lift is a type of neck lift procedure performed directly in the anterior midline portion of the neck.

Image courtesy of: Archives of Plastic Surgery 2234-6163 2234-6171 

This type of procedure is quick and effective.  It can easily remove excess skin, tighten loose muscle, remove excess fat, and increase neck definition.  The primary drawback for this procedure is the prominent scar in the midline of the neck.

With scar management, the scar will subside, but there is always a visible scar in Dr. Athre’s opinion.

Dr. Athre rarely uses this type of neck lift for that reason.  It is, however, a realistic option in an aged male patient who usually wears a beard.

The deep neck lift is the type of lift Dr. Athre uses most often for aging in the neck area.  The deep neck lift works well in patients who:

1. Have any amount excess fat from mild to severe
2. Have sagging skin of the neck (mild to moderate)
3. Have little to no aging of the midface
4. Have slight aging of the jawline

Photo of deep neck lift

In a deep neck lift, an incision is made under the chin, and behind each ear.  Through the incision under the chin, excess fat is removed, the platysma muscles are tightened (platysmaplasty), and droopy (ptotic) deep neck structures (fat, submandibular glands) are removed.  Next, the platysma muscle is tightened via the incision behind the ears, and excess skin is removed through the same incision.

This type of neck is very effective in addressing the neck.  Shortcomings to the deep neck lift are:

1. Patients with severe excess skin will be better served with a facelift
2. The neck lift does not address any aging of the midface.  Patients with aging in the midface, or severe laxity along the jawline will again be better served with a facelift

The aesthetic for the neck is a long, toned, defined neck.  Thus far, aging of the neck has been the only variable discussed with loss of definition in the neck.  A common cause of loss of definition in the neck is a posteriorly placed chin.

Patient with neck fullness and posterior position of chin.  The posterior position of the chin shortens the neck and increases the fullness and lack of definition in the neck.

The same patient is shown 5 days post operative after a chin augmentation, neck liposuction, and deep neck lift.  The liposuction and deep neck lift increased the definition of the neck by tightening and redraping the tissues.  But the chin augmentation increased the projection on the chin, and lengthened the neck.  Chin augmentation is a common ancillary procedure with neck lift surgery.

Most patients are bombarded with information about nonsurgical face and neck rejuvenation.  Some of the options include Exilis, Morpheus, etc.  All of these devices use energy such as radiofrequency energy, ultrasound energy, or microwave energy to heat tissues and increase the tensile strength of these tissues.

These types of energy devices primarily tackle the skin and increase contractility of the skin.  Aging in the neck is primarily due to loss of tone in the platysma muscle, and the supporting structures for the deep structures in the neck.  These devices will only work on patients with minimal skin laxity and no laxity of underlying structures.

Dr. Athre is a double board-certified plastic surgeon.  He has performed thousands of facelift and neck lift operations.  In essence, neck lift surgery is a type of facelift surgery, except that it targets only the lower 1/3rd of the face.  It is extremely important to address a patient’s concerns, but also determine which type of lift surgery is most appropriate for their anatomy.

Many patients come into Athre Facial Plastics asking for neck rejuvenation.  After careful examination, Dr. Athre will counsel them on which patients are appropriate candidates for neck lift vs. which candidates would be served better with a face lift.  If such factors are not carefully taken into account and explained to the patient, the patient may end up dissatisfied if they have a tight neck and still have a saggy, droopy face.

These procedures are performed under local anesthesia or local anesthesia with oral sedation.  Normally, general anesthesia is not required.  However, patients requesting general anesthesia or extremely anxious patients may benefit from having their procedure performed at an outpatient surgical facility under general anesthesia.

All patients under local anesthesia or local anesthesia with oral sedation are discharged home approximately 30 minutes after their neck lift surgery is completed.  Patients undergoing general anesthesia are also discharged home the same day as surgery.

Most patients are able to return to daily life activities within 24 hours and return to full normal activities in 5-7 days.

Are the results of a neck lift permanent?  Yes.  The way that Dr. Athre performs neck lifts is permanent.  The tightening effect of the skin and muscle is permanent.  However, you will continue to age.  Patients who need neck liposuction alone will likely return back for some sort of definitive muscle or skin tightening procedure in 3-5 years.  Patients that undergo a deep neck lift will likely have another procedure 12-15 years later in the neck, but might need a procedure to address midface aging sooner.