Aging of the neck presents in many different forms, from changes in the skin, to muscles, to deeper structures like submandibular glands and fat. There are myriad techniques we use for the improvement of these many changes.
Neck rejuvenation and contouring procedures are challenging and continually advancing. Although the techniques are evolving, the anatomy is constant, and surgeons with a firm understanding of the anatomic relationships within the neck are able to deliver consistent and aesthetically pleasing results for their patients.
WHAT IS A NECK LIFT?
On occasion, an isolated neck lift is possible. More often, it is performed in conjunction with a lower face lift. Isolated neck lifts take many forms, depending upon the changes that may be present and addressed. Limited incisions behind the ears are sometimes employed to tighten some of the loose neck skin. However, a complete neck rejuvenation is rarely possible with limited incisions.
A submental incision (incision hidden below the chin) is also used to remove fatty deposits in this area and to tighten muscle bands. Finally, Giampappa sutures are employed: these are criss-cross sutures which allow tightening of the deeper structures and fixation to the tissues behind the ear (mastoid fascia). As can be seen, isolated neck lift procedures take varied forms.
AM I A CANDIDATE FOR A NECK LIFT?
Patients that are good candidates for an isolated neck lift are patients with the following:
Loose neck skin without much laxity of the lower face and jawline
Moderate neck bands
Moderate submental fullness
Any combination of the above and as long as the patient understands that the lower face and jaw line will not be improved by the neck lift.
This patient had neck liposuction and the use of Giampappa sutures to give her a partial improvement of her neck. Surgery was also performed on the upper two-thirds of her face (brow lifts, upper and lower blepharoplasty and cheek lifts, that we designed and call the Hammock Lift
WHY THE NECK?
People divide the face and the neck, but the appearance of the neck has a huge bearing on the appearance of the face.
In the illustration to the right, I have only changed the fullness of the neck. The secondary effects make the face look much older. So it pays to define the neck as best as one can.
By choosing to do an isolated neck procedure with lasers or surgery, you will get some improvement of the neck and the face. By choosing to going for the whole Monty and improving the neck properly with a defined facelift and necklift, you get the best results!
HOW WILL I BE ASSESSED?
Examination of the neck structures as described under the “Conditions” Neck section will allow one to determine if an isolated neck rejuvenation procedure is a reasonable option. It is important to remember that with the neck, tissue restitution occurs: this is a concept that is not well-known in plastic surgery or, is at least not well appreciated.
Essentially, what you see immediately after surgery is NOT what you get in the medium or long term. The skin of the neck and décolleté is prone to develop fine lines, deep-set lines, loss of skin elasticity and discoloration. Neck skin is thinner than facial skin. The face has 30 times the pilosebaceous units than the neck or chest and 40 times that of the hands and arms. Therefore, neck skin responds more slowly to any surface skin treatments like lasers and chemical peels.
WHAT OTHER PROCEDURES MAY BE PERFORMED WITH A NECK LIFT?
The commonest procedure performed at the same time as a neck lift is a face lift. This combination gives a congruous improvement from the midface all the way down to the neck. Other procedures include liposuction of the neck, chin augmentation, and platysma plication.
This patient had a Hammock lift with neck liposuction which gives her an improvement in the jawline and neck without a full facelift and necklift.
ISOLATED NECKLIFT PROCEDURES EXPLAINED
This patient had an isolated necklift procedure where liposuction, Giampappa sutures to tighten the tendons and excision of a small amount of skin behind the ears was done. This was not a full facelift and necklift so you can see that although there is an improvement in the neck, there is still some laxity and presence of jowls.
However, the patient has a more defined neck and a better jawline. This procedure takes about one hour and 30 minutes (compared to a full facelift and necklift which takes 3 to 5 hours and is more involved)
ANOTHER EXAMPLE WITH EXPLANATION
The beauty of a well-performed Hammock Lift: the Hammock Lift includes manipulation of the brow shape, upper and lower blepharoplasty and cheek lifts, which gives her the nice improvement in the top two-thirds of the face.
The improvement in the neck is from liposuction and limited incision neck tightening. Again, not as great a result with the neck as we can get with a proper facelift and neck lift, but an excellent result with an isolated neck procedure. Patient sent her sister in for the same procedures!
FOR THE BEST RESULTS
With a 3-D procedure, there are several layer of sutures, accurately placed to give the lifting, tightening and filling, without leaving any tell-tale pull-lines. Some are slow dissolving sutures, others are more permanent. The skin sutures are generally removed between 7 and 14 days.
Bleeding is not common as we pay close attention to proper hemostasis. On rare occasions, a small hematoma may collect.
Everyone will experience some numbness in the face: this resolves over weeks to months. This occurs because of the dissection of the face. This is not a complication.
Because of the dissection and repositioning of the tissues, it is common for there to be small differences in the smile between the right and left sides: this is usually only noticeable to the patient and to Dr. Patel! It recovers over a few weeks.
All faces have asymmetry and there will be some degree of asymmetry. This is to be expected.
Permanent weakness of nerves and muscles is rare.
The scars are usually very well hidden. However, some patients may have a tendency to cause hypertrophic scarring: in such cases, certain lasers and treatments will help. By-and-large, scars are rarely a problem. With Caucasian skin, pinkness of scars is to be expected for several weeks. With darker skin, some hyperpigmentation may occur.
In the first few days, everyone will experience some degree of dryness and blurry vision. You will also feel that your lids look a little tight on the outer corner where you will also feel some of the deeper sutures if you put your finger there: this is of no concern. The tightness and the bumps under the skin settle over a few weeks.
More serious complications which are very rare include excessive bleeding, hemorrhage and loss of vision.
VEIW OUR EVER-EXPANDING COLLECTION OF EDUCATIONAL, TECHNIQUE AND TEACHING VIDEOS
WE ARE HERE FOR YOU
CONTACT DR. PATEL
Do you have questions or need more answers?
Dr. BCK Patel MD, FRCS
Salt Lake City, Utah 84106, USA
(801) 413-3599 (phone/text)
Dr. BCK Patel MD, FRCS
617 E Riverside Dr Suite 101
Saint George, UT 84790, USA