What is a neck lift?
Difference Between a facelift and a neck lift
Deep plane neck lift
Selecting your surgeon
The neck angles and contour play a critical role in portraying youth and defining beauty. A smooth, defined jawline and a sharp cervicomental angle are hallmarks of a youthful neck. As we age, loose tissue and a loss of definition in our neck can become visible and bothersome. Skin and muscle laxity is especially pronounced in photographs and our profile view when we tuck our chin down. The smooth, crisp jawline and defined neck of our youth is lost as the skin loses its elasticity and the platysma muscle begins to loosen and hang. For some patients, a genetically inherited fullness of the neck is present all throughout adulthood.
Neck rejuvenation can be accomplished with surgical and non-surgical treatment methods. Liposuction of the neck and jawline is a commonly performed cosmetic procedure to reduce superficial fat underneath the skin and improve the neck contour. Radiofrequency (RF) and combined microneedling-RF treatments are becoming increasingly popular as minimally invasive non-surgical methods to treat neck laxity. These treatments can be done in the office under local anesthesia only. However, none of these treatments address the muscle (platysma) or the sub-platysmal deep structures of the neck.
WHY UNDERGO A NECK LIFT?
A surgical neck lift is often necessary to tighten the platysma muscle and improve the cervicomental angle. The cervicomental angle is the angle between the horizontal plane underneath the jaw and the vertical plane of the neck. For some patients, neck structures which lie deeper to the muscle such as sub-platysmal fat pads, low-hanging submandibular glands and bulging digastric muscles can be addressed in surgery in order to achieve optimal results. Neck liposuction is often performed at the same time as a neck lift, in order to remove excess fat below the skin.
The goal of a neck lift is to restore beauty and youth to the neck without creating permanent signs of surgery or changing the identity of the patient. The ideal neck lift results in a younger appearing and more rejuvenated version of the patient. At Sharma Facial Plastic Surgery, our goal is to help you match your radiant, inner energy with a natural appearing, more youthful version of yourself. We pride ourselves in delivering the most advanced solutions to produce exceptional and natural results.
DIFFERENCE BETWEEN FACELIFT AND NECK LIFT
A deep plane facelift addresses the midface (cheek and nasolabial folds) and lower third of the face (jawline and jowls). Facelift incisions (2) are placed on each side of the face inside the temporal hairline, around the natural creases between the ear and the face, and end inside the hairline behind the ear along the upper neck. The lateral aspect of the platysma (neck muscle) is dissected via the deep plane through facelift incisions and repositioned to add volume to the angle of the jaw.
A neck lift addresses excess skin, fat and muscle in the neck, below the jawline. The neck lift incision (1) is placed in the natural submental crease of the neck, directly behind the chin. This allows central access to the superficial neck fat, which can be removed with liposuction, and the central merging point of the platysma muscles which drape across the neck and jawline on each side. As we age, this midline connection loosens, resulting in hanging, vertical bands in the neck. Through the neck lift incision, the platysma muscle is tightened across the middle and secured to deeper neck structures in order to sharpen the cervicomental angle. This maneuver is called a platysmaplasty, and improves the definition between the jaw and neck. Tissues deeper to the platysma, such as fat pads, muscle and salivary glands can be sculpted and repositioned in a deep plane neck lift to optimize the neck contour.
For many patients, a facelift is combined with a neck lift to achieve comprehensive rejuvenation of the lower two-thirds of the face and the neck. For some patients who have only neck laxity and fullness, a neck lift with or without liposuction may be adequate.
DEEP PLANE NECK LIFT
For some patients, anatomic structures such as fat, muscle and saliva glands which lie deep to the platysma muscle contribute to neck fullness. In these cases, if only a platysmaplasty is performed without addressing the deeper tissues, patients can experience residual bulging under the chin and jawline which can be very bothersome after surgery. These patients may feel like they did not achieve the full result of the neck lift which they were hoping for.
A deep plane neck lift can be performed to reshape and sculpt enlarged sub-platysmal fat pads, low hanging submandibular glands and bulging deep neck muscles (e.g., digastric muscle). This is performed before tightening the platysma muscle (platysmaplasty), which is generally the final step of a neck lift. Laterally in the neck, the cervical retaining ligaments are released to optimize the neck lift. Deep plane neck lift dissection is only performed by plastic surgeons who have a detailed understanding of neck anatomy and are comfortable operating in different planes of the neck.
SELECTING YOUR SURGEON
If you are considering a neck lift, it is important to select a surgeon who specializes exclusively in plastic surgery of the face and neck. Facial and neck anatomy is the most complex anatomy of the body. Hence, having a surgeon who has an in-depth understanding of the anatomy and is highly experienced with neck surgery is important to achieve highest quality results and to minimize the risk of any complications.
As an Otolaryngologist / Head and Neck Surgeon who specializes in Facial Plastic Surgery, Dr. Sharma has spent his entire training and career operating exclusively on the face and neck. His vast experience in neck surgery ranges from neck lifts, thyroid surgery, submandibular gland surgery, jaw surgery, as well as complex neck dissections for cancer patients and airway reconstructions. Facial Plastic Surgeons with an Otolaryngology / Head and Neck Surgery background are uniquely qualified to perform complex facelift and neck lift surgery given their educational background and operative scope focused exclusively on the face and neck.
FREQUENTLY ASKED QUESTIONS
What level of anesthesia is required for a neck lift?
A neck lift consisting of a platysmaplasty only can be performed under local anesthesia (lidocaine and Marcaine, injected under the skin) and oral medication for pain and relaxation. A platysmaplasty neck lift can be combined with neck liposuction, if necessary. A deep plane neck lift is a more extensive surgical procedure and would require either IV sedation (without general anesthesia or a breathing tube) or general anesthesia. There are multiple considerations and factors which determine which level of anesthesia is best for a particular surgery. These include patient comfort and safety, the number and type of procedures being performed (e.g. combining neck lift with a facelift, browlift or other facial surgeries), risks of surgery , duration of surgery, patient age and overall health to name a few.
When undergoing facelift and neck lift surgery, whether you are undergoing IV sedation or general anesthesia, it is important to have an Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) present in the operating room. This ensures there is always a certified medical professional monitoring your health and safety while your plastic surgeon operates. Some surgeons perform facelift and neck lift surgery in private surgery centers or clinics under sedation without an Anesthesiologist or CRNA present, managing their patient’s pain levels, blood pressure, heart rate, and oxygenation levels themselves while operating. This results in fluctuating levels of sedation and pain, creates a distraction for the surgeon and OR nurses, and most importantly jeopardizes patient safety.
IV sedation or general anesthesia administered by an Anesthesiologist or CRNA are very safe and associated with very low complication rates. Most patients are awake within 20 to 30 minutes after their surgery and ready to be discharged home. You should talk to your surgeon about anesthesia for facelift and neck lift if you have any questions!
How long should I plan to take off work?
Dr. Sharma advises his neck lift patients to take approximately 2 to 3 weeks off of work. This allows adequate time for post-operative swelling and bruising to heal (one week). Sutures are removed within the first 7 to 10 days after surgery. Dr. Sharma recommends no exercise for the first 2 weeks after surgery and limiting any strenuous physical activity for the first month. Lastly, your overall energy level should return to normal after 1 to 2 weeks after surgery.
How much swelling and bruising can I expect after a neck lift?
All facelift and neck lift patients will experience some degree of swelling after surgery. Swelling can be minimized with meticulous surgical technique and good post-operative care. Swelling generally peaks on days 2 and 3 after surgery and the majority subsides over the first week. The remainder of swelling can take a few months to fully subside. Supplementary medications such as arnica and bromelain can help reduce the amount of post-operative swelling.
How much pain can I expect after a neck lift?
For the majority of Dr. Sharma’s facelift and neck lift patients, there is no significant pain after surgery. Common symptoms in the first week after neck lift surgery are tightness in the neck and some discomfort from swelling. The majority of our patients use over-the-counter pain medications such as extra-strength Tylenol (acetaminophen) for the first 1 to 2 days after surgery. Although prescription-strength pain medication is available for our surgical patients, it is rare for patients to have significant pain which requires opioid or narcotic pain medications in addition to Tylenol.
When will I feel comfortable being out in public and when will I get my final result?
If undergoing a necklift alone, most patients are comfortable being out in public within 2 to 3 weeks after surgery. When combined with a facelift, recovery lasts a little longer and patients are generally comfortable with public appearances by 4 weeks. By this time, the early swelling and any bruising will have resolved and the surgical incisions are starting to conceal well behind the hairline and ear. Swelling will continue to reduce over the next several months. By months 3 to 4 after surgery, most patients can better appreciate their rejuvenated neck. These timeframes can vary between patients depending on their anatomy, overall health and surgical procedure(s) performed.
Case 1: 59 year old female who underwent Total Facial Rejuvenation surgery. 6 week result. She had a heavy brow and eyelids, midfacial volume loss, jowls and severe laxity of her neck skin and deep neck structures. She underwent an endoscopic brow lift, upper and lower blepharoplasty, facial fat grafting, extended deep plane facelift and deep plane neck lift.