Q – What is a neck lift?
The neck lift, also known as submentoplasty, is a procedure that lifts and rejuvenates a sagging and/or full neck and jawline.
Q – Who is a good candidate for a neck lift?
The best candidates for a neck lift include healthy men and women who are bothered by unwanted sagging of the neck and/or jawline. Most patients complain that they look prematurely aged due to excess laxity that drapes down below the jaw and/or undesirable fullness below the chin. These changes are usually the result of a combination of three different components that need consideration – loose skin, muscle sagging (termed platysmal banding), and excess fat. Loose skin is a result of the aging process, which causes excess laxity and gravitational pull. Muscle sagging reflects what the aging process does to the thin wide muscle sheet (the platysma) that extends all the way across the neck. Each side has a platysma muscle that normally does not meet in the middle and, as the aging process advances, the edge of the muscle on each side begins to sag downward leading to two visible bands the extend from just below the chin toward the collarbone. This contributes to what is often described as a ‘turkey gobbler’ deformity (combined sagging skin and muscle). Patients with excess fat have unwanted fullness below the chin that contributes to a poorly defined jawline. All three components can coexist in the same patient and lead to the appearance of a premature aging neck.
Patients with all three components of an aging neck usually undergo a neck lift with or without combined facelift. If there is excess fat present under the chin, the neck lift can be combined with liposuction (liposculpture) performed through a short incision under the chin. In rare cases a slightly wider incision is used to remove the fat directly, termed an open lipectomy. If platysmal banding is present, these should be tightened through a hidden incision made below the chin. The edges of the two sides of the muscle are quilted together much like a corset to create a sharp new neckline (like a hammock), termed a platysmaplasty. Inevitably there is excess skin laxity noted after the platysmaplasty, which requires an incision behind the ear to further lift and tighten the neck line. In some cases of skin laxity, muscle banding and fat excess involving a male neck, a ‘direct neck lift’ may be performed. Because this involves the placement of a slightly longer incision under the chin, it is usually reserved for male patients whose skin tends to hide the incision in a more favorable fashion.
Q – Where is the neck lift procedure performed?
Neck lift surgery is usually performed in an outpatient surgery center, often times in conjunction with a lower facelift. Many direct neck lifts can be performed as an office-based procedure.
Q – What type of anesthesia is used for a neck lift?
Most neck lifts involve deep sedation or general anesthesia. A straight local anesthesia can be used if a direct neck lift is being performed in the office setting.
Q – How is the neck lift procedure performed?
The neck lift involves incisions hidden predominantly behind the ear with only a short extension needed along the front of the ear. The skin is separated from the underlying tissue and the platysma muscle is identified below the jawline. The back border of the muscle is mobilized then lifted upward and the muscle is secured to the bone just behind the ear with multiple sutures. By pulling the back edge of the muscle upward, the front and side of the neck are effectively tightened. The incision is then closed carefully with fine sutures.
If the front of the neck requires liposuction or platysmaplasty, this is typically performed prior to the remainder of the neck lift. For liposuction, a short incision is made under the chin and a narrow suction device is used to remove the excess fat, thereby sculpturing and reshaping the neck. In rare cases, a slightly wider incision is required to remove the fat directly, and this is termed an open lipectomy. For platysmaplasty, an incision is made below the chin and the edges of the two sides of the muscle are quilted together much like a corset, creating a sharp new neckline. There is inevitably excess skin laxity noted after the platysmaplasty and this requires an incision behind the ear to further lift and tighten the neck line.
For a direct neck lift to treat skin laxity, muscle banding and fat excess in the male neck, an intentionally irregular-shaped incision (termed a W-plasty or Z-plasty) is made under the chin. This shape helps to fool the human eye as the eye tends to notice straight, linear scars more easily. A certain amount of excess skin is excised directly under the neck. The muscle can then be tightened under direct vision if necessary and excess fat removed as needed through the open incision. The skin edges are then brought together carefully and closed in meticulous fashion with fine sutures.
Q – How long does the neck lift take to perform?
A neck lift can take between one and a half to three hours to complete depending on what approach is being used and how much work is being done.
Q – Where are the incisions made for the neck lift?
The incisions for the neck lift are hidden behind the ears with a very short extension around the front of the bottom of the ear (the lobule). If liposuction or platysmaplasty are being done as well, a short incision is also made just below the chin. Incisions for a direct neck lift are placed entirely under the chin along the front of the neck.
Q – Are there scars after a neck lift?
Though the incisions made for the neck lift will result in scars, they tend to be well-concealed as they are mainly located behind the ear and sometimes beneath the chin.
Q – Is the neck lift a painful procedure?
Patients may experience some discomfort which is well controlled with low dose prescription narcotic medication.
Q – What is the recovery like after a neck lift?
During the first few days after the neck lift, patients should sleep with the head slightly elevated at a 30 degree angle to minimize swelling. Patients are also encouraged to minimize rotation of the neck. Any pain or discomfort that patients experience is well controlled with low dose prescription narcotic medication. Patients will be seen within one to two days after surgery for bandage dressing change and then within four to seven days after surgery to have the sutures removed. Swelling and bruising may still be noticeable for up to ten days after surgery. In most cases, patients will note a sensation of feeling ‘tight’ for several weeks, though they will not appear tight. This is an expected feeling that will slowly fade away as your neck becomes more familiar with its new contour and position.
Q – When will I be able to return to work after undergoing a neck lift?
Most patients are able to return to work within seven to ten days after the neck lift, sometimes sooner for those patients not bothered by residual swelling.
Q – When will I be able to exercise after my neck lift?
Aerobic activity (reconditioning) may be resumed within ten to fourteen days after the neck lift and more strenuous activity (resistance workouts) within three to four weeks.
Q – When are the stitches removed after the neck lift?
The stitches are removed within four to seven days after the neck lift.
Q – Are there risks or complications with the neck lift?
As with all types of surgery there are potential risks associated with the neck lift. By virtue of the anatomy in the area, there is a potential risk of damaging the nerve that controls movement of the mouth region. However, knowledge of where this nerve runs essentially minimizes the chances of this complication occurring. Some patients may note temporary numbness around the ear due to swelling near the sensory nerve in this area, though permanent numbness is very rare following neck lift surgery.
Q – Does insurance cover the neck lift procedure?
Neck lift procedure which are performed for cosmetic purposes are typically not covered by insurance, though patients will need to check with their own insurer.
Read more about San Diego necklift procedures.