Skin laxity, muscle banding, and fatty deposits are common problems associated with aging of the neck. The neck muscles extend from beneath the jaw down and around the neck itself, and these muscles tend to weaken over time. As the muscles become more lax, fat deposits begin to collect around them and the skin attached to the muscles begins to loosen and droop. Dramatic weight gain or loss, sun exposure and smoking exacerbate this effect. Due to genetic predisposition or weight gain, even the younger patient can be unhappy with the contour of their neck.
Making the Decision
The approach to improving the neck contour varies depending upon the patient’s age, skin and desired result. Patients with a significant amount of loose facial skin and neck muscles may require a full lower neck lift procedure (see Rhytidectomy). In this procedure, excess skin is lifted and removed and the remaining skin re-draped. For a neck lift, incisions are typically made behind the ears where they are hidden from view. For men, the incision is aligned to accommodate the natural beard lines. For men, all incisions are aligned to accommodate natural beard lines.
This is often combined with sub-mental liposuction for removal of excess fatty deposits. When neck muscles have banded, your surgeon may recommend Platysmaplasty surgery. The surgeon makes incisions under your chin and/or behind your ears to access the platysma (neck muscle) and manipulate it accordingly. The surgeon will permanently suture areas of the muscles in order to clasp them in the best position.
Patients who are a bit younger with good skin tone who are more concerned with fatty deposits may benefit from sub-mental liposuction. When skin still has good elasticity, it simply conforms to the neck's new shape without removal of skin. Those requiring more projection or an improved jaw-line contour would benefit from a chin implant (see Mentoplasty), or a pre-jowl implant to re-contour the jaw line. These implants, combined with any or all of the above mentioned procedures simply enhance the results by adding or taking away for the most aesthetically pleasing shape. It may be necessary to combine some or all of these procedures for best results.
Understanding the Surgery
Neck lift procedures can be done with local anesthesia and intravenous (IV) sedation or general anesthesia. The extent of the procedure often determines which kind of anesthesia should be used. For the lower face/neck lift surgery, the incision begins in front of the ear lobe and loops in and around the ear and into the hairline behind the ear. For men, the incision is aligned to accommodate the natural beard lines. If a platysmaplasty, sub-mental liposuction or chin augmentation is performed, there will be an additional tiny incision under the chin for easy access. Length of time varies by procedure, and all surgeries are performed as an outpatient.
Chin liposuction, also called sub mental liposuction, is a safe procedure that creates a very aesthetically pleasing result. The procedure usually lasts less than an hour and can be done under local anesthesia (i.e. anesthetic is injected under the skin while the patient is awake), IV or general anesthesia (i.e. the patient is unconscious or “put to sleep”). If you are having a procedure under local anesthesia, you may take some oral medication to help you relax. The neck is numbed with local anesthetic and the area is infiltrated with saline using an approach called the tumescence technique. This technique helps “lift” the skin off of the underlying tissue so that the powered liposuction cannula can reach all areas of the neck and chin. The thin liposuction cannula is inserted into these tiny incision areas and uses high frequency oscillations to liquefy and gradually remove the fat and then suck it out through something like a vacuum. The surgeon’s goal is to sculpt the fat gradually for best results, not to completely remove all of the fat.
What to Expect After Surgery
Following the surgery, the surgeon will apply a compression bandage to protect the entire area where the incisions have been made. Some degree of discomfort, swelling and bruising is unavoidable. You will be prescribed medication for pain management and you will be instructed to use cold compresses and sleep elevated for the first few days to keep swelling to a minimum.
In some cases, a drainage tube may have been inserted during surgery. This, along with compression bandage, will be removed two days after surgery after which a “jaw bra” will be worn for about one week. For a full neck lift, or platysmaplasty, sutures and staples are usually removed within 7 to10 days and most patients return to work in 2 weeks. With sub-mental liposuction, healing is much quicker with some returning to work in as little as 2-3 days. As with all surgery, there is always a risk of delayed healing.
Scars are usually not noticeable after they mature as they are easily disguised in natural skin creases along the hairline or underneath the chin. Makeup may be worn to camouflage until total healing has occurred and scar bandages may be used to hasten the healing process.
Keep all post operative appointments as scheduled. Anything unusual should be reported to your doctor immediately.