The neck is a common area of concern. It can be too full of excess fat, the skin can be too loose from aging or weight loss, and the angle between the neck and jawline can be such that the neck appears short. For the right patient, necklift can produce very dramatic results with a relatively quick and easy procedure.
What is the anatomy of the neck and is this important?
To understand what can and what cannot be accomplished with a necklift, it is essential to understand the anatomy of the neck. The neck consists of skin – under the skin is a layer of fat referred to as the sub-cutaneous or superficial fat – under the subcutaneous fat is the platysma muscle – under the platysma muscle are important nerves, blood vessels, and glands, but also, importantly, another layer of fat called the sub-muscular or deep fat. So think in layers: skin, superficial fat, muscle, then deep fat. In planning a necklift, I consider each layer, and how best to treat the layer.
How is the necklift performed?
There are multiple options for a necklift, and the correct procedure for you is determined by your anatomy.
If superficial fat is the only problem, liposuction is an effective procedure. Through tiny incisions under the chin and near the back part of the ear, a thin tube is inserted and the outer fat is suctioned away. This is generally an easy procedure to perform under local anesthesia, and while your activity is limited for a few weeks, and you’re asked to wear a compressive sling under the chin, there is very little discomfort. Liposuction alone does not correct problems with the skin, muscle, or deep fat.
If the angle between your neck and jaw is not ideal (it should be close to 90 degrees), frequently work on the platysma muscle must be performed. This muscle is a vestigial muscle, meaning it does not have any significant functional purpose, but it can contribute to a “turkey neck” and can be cut and brought together to produce a “sling” under your chin. This is done through an incision under the chin and requires some sedation so it is only performed in a hospital or surgery center. Most people take 5-7 days off work, and there are activity limitations for a few weeks following surgery.
If the deep fat is excessive, which is very common in people who have a chubby neck or a poor neck-jaw angle, the deep fat can be removed at the same time that the platysma muscle is approached. This can produce dramatically pleasing changes in the angle of the neck, and like the muscle, work is performed in a hospital or surgery center with 5-7 days off from work.
If the skin is very wrinkly, loose, or saggy, frequently skin needs to be removed. This may require an extended necklift, where incisions are placed behind the ear so that the extra skin can be removed. Skin can be removed and tightened, but the quality of the skin cannot be changed with any surgical procedure.
What about jowls – can these be approached through a necklift?
The short answer is no! Patients frequently pull back on their neck skin with their fingers and if you pull just right, you can improve the jowls. Unfortunately, that can’t be done with surgery. If the jowls are too full, liposuction may be a solution, but if they sag, a facelift procedure (perhaps just a lower facelift) will be necessary. A necklift cannot improve anything at or above the lower edge of the jaw.
What about full glands in the neck – can these be approached through a necklift?
Yes. The sub-maxillary glands are often enlarged and may sag below the jawline. The gland can be reduced in size which will improve your neck and jawline.
What about lasers and injections to treat neck problems?
External lasers and associated energy technologies can produce subtle changes in the neck, but I emphasize subtle. Laser type treatments can vary slightly tighten skin and can improve discoloration and fine wrinkles, but the results are often a disappointment to patients. We will discuss them at your consultation. Injections of medication into the neck referred to as mesotherapy, can definitely reduce superficial fat, and to a limited degree, can reduce the deep fat. Kybella© is a currently available mesotherapy medication. For all but very small fat collections, multiple treatments separated by a minimum of 4-6 weeks are required. There is usually quite a bit of swelling, which can take up to a week to resolve, and mesotherapy does not remove excess skin. If any substantial amount of fat is removed, hanging of the neck skin is common.
Are there related issues that contribute to an unattractive neck or profile?
Very commonly, patients who require a necklift to enhance their profile will also benefit from a chin augmentation. In your consultation, I will perform computer imaging to show you the benefits of the necklift with or without chin augmentation. For information on chin augmentation, see Chin Augmentation on this website.
Who is the ideal candidate for a necklift?
Patients who are the best candidates for a necklift alone (as opposed to combined with a facelift) are generally mid-40’s or younger, have good skin tone, and have poor definition between the neck and jawline.
Are there risks to a necklift?
All surgical procedures carry some risks but generally, they are quite small – these will be discussed in detail with you at your consultation.
To learn more about what you can expect during a Necklift Procedure, or to schedule your consultation with Dr. Barnett at either his San Francisco or Walnut Creek office, please complete the form on this page or call 415-362-1221