Necklift Surgery Explained
Necklift Before and After
What is a neck or cervical lift:
As we age many people will accumulate some fat under the chin, and some heaviness throughout the neck. The platysma muscle can also start to separate resulting in “bands” in the neck. And many people will start to develop some jowling along the jaw line. If the changes in this area are mild, then non-surgical options such as Ulthera can help. This is a deep ultra-sound treatment that will tighten the neck and jowls.
There are also a variety of surgical options. If you just have some fat under the chin, liposuction can be done to remove the fat. If you have more significant laxity in the neck and have some muscle bands, a neck lift will usually be necessary. This surgery will tighten the neck and improve the jowls. If you also have deep nasolabial folds and some fat descent in the cheeks, then you should consider a full face and neck lift.
One of the most common complaints patients have about their appearance is laxity and wrinkling in the neck, and jowls. During the exam I first evaluate the area under the chin. This is where there will be deposits of fat, and also where we can see the separation of the plastyma muscle causing banding. If these are present, an incision will need to be made under the chin to tighten the platysma muscle.
Next the amount of skin laxity throughout the neck is evaluated. If there is only a small amount of skin, then a surgery with a shorter incision may be possible. The jawline and amount of jowling are also examined.
With a mirror we can show the patient how a surgery should improve their appearance. This will help them to decide if they want just neck liposuction, a neck lift, or a full face and neck lift. For patients wanting just the neck, the plastymaplasty is usually performed to improve the angle of the jawline.
The projection of the chin is also evaluated. If someone has a weak chin, the angle of the jaw will not be well defined. Placement of a chin implant can greatly improve the jawline. Many patients are concerned that they will not look natural with a chin implant. However a properly sized and placed implant can make a big yet natural improvement in the appearance of the neck. (picture of chin implant)
The first thing we do is to mark the face where incisions will be made. One line will be drawn under the chin in the normal submental crease for access to the platysma muscle. A line will be drawn from in front of the ear lobe, passing under the lobe and then up behind the ear. Near the top of the ear this line will extend back toward the hairline.
Local anesthesia is injected into the neck and along the previously marked lines. A small incision is then made under the chin if liposuction is going to be performed. A larger incision is then made under the neck to find the platysma muscle and the muscle bands are sutured together. An incision is then made along the line around the ear. The skin of the neck is elevated off the underlying fat and muscle. Several sutures are then placed in the lateral portion of the neck to tighten the deep tissues. Excess skin is then excised and the skin is closed with suture.
For a cervical lift we usually use local sedation anesthesia. An IV is placed before the surgery to administer sedation. After the surgery the patient stays in recovery for about one to two hours before going home. Some patients elect to do the surgery with just local anesthesia. The injections of the local anesthetic are uncomfortable, but once these are given there should not be any further pain.
A dressing is placed around the neck and head for the first 24 hours. This is removed the next day and an elastic support dressing applied. Ice is used for the first 3 days followed by warm compresses. If a drain was placed under the skin this is removed between the first and fourth day. Sutures are removed between day 7-10.
Patients will be bruised and swollen for at least one to two weeks. Much of the bruising will move down into the chest. There is usually not much pain with this surgery, and can be controlled with Tylenol. There will be a tight sensation in the neck when moving the head, and swallowing may be uncomfortable the first couple of days.
Some patients may have significant bruising and swelling which can last several weeks. On a rare occasion bleeding can occur in the first 24 hours post-op with a hematoma forming. When this occurs the patient is brought back to the operating room to remove the hematoma and stop any bleeding. This does not affect the final outcome of the surgery.
Some patients may note some relaxation of the lift after a few months. If this occurs, a revision with additional tightening can be done after 6 months.
Some people may also note some swelling in the neck due to the gland under the jawline. We all have this gland, but it may become more noticeable after fat is removed and the skin is tightened. We usually can advise people about this pre-op if they have a large palpable gland. There are some surgeons who can take this gland out if the patient wants this done.