Overview
 |
Example
of neck suspension technique. Notice the dramatic improvement
of both neck angle and jaw line. Click to enlarge. |
The effects
of aging show early within the neck region. The skin begins
to hang loosely and the muscles underneath lose their tone. These changes produce the characteristic look of the aging
neck. If you look at any young person who is not overweight
you will see that the skin is closely adherent to the neck
creating a very sharp angle at the level of the Adams
Apple. This angle is called the cervico-mental angle
and makes a profound impact on the appearance of the neck.
 |
| Notice
how the cervical-mental angle is restored from essentially
a hanging flat line to a more youthful angle. |
In youth, the cervico-mental angle is
very sharp approaching 70 degrees. As one ages or gains weight,
this angle becomes flatter and flatter for different reasons. With aging, both the skin and the muscles become lax. The
muscles form cords that draped down from the chin giving the
characteristic turkey neck appearance.
With weight gain, the angle flattens
because of the excess subcutaneous fat. The treatment for
these two problems is completely different.
 |
| Notice
the characteristic banding of the plastyma muscles in
the Before. This turkey neck appearance is
eliminated in the After. Also notice the improved jaw
line and marked reduction of jowling. Click
to enlarge. |
In the case were the cervico-mental angle
has flattened because of fat accumulation within the subcutaneous
tissues, most plastic surgeons can normally improve the neck contour
with liposuction, with or without
a neck lift. When liposuction is performed on the neck two
things happen. One, the subcutaneous fat is removed and two,
during the healing process the skin redrapes more tightly
against the neck creating a leaner appearance with a sharper
cervico-mental angle.
The process of facial aging is described
more thoroughly below and within the pages describing face
lift. The key
to neck lift surgery is to tighten the underlying muscles
that have become lax, re-create a sharp cervico-mental angle,
create a well-defined jaw line, and then redrape the skin
to accommodate the new contour. It is important to understand
that the majority of the work needs to be done underneath
the skin level. It is not just a skin tightening procedure.
It is a very exciting time in plastic
surgery because we are just beginning to ”solve the
puzzle” of facial aging. Even though facial aging affects
the entire face and neck, sometimes a patient is really only
concerned with a particular area such as the neck. In this
situation, only the neck needs to be addressed. Often the
patient will return to have their face and eyes done when
they are ready. This is an excellent way to approach facial
rejuvenation. You should only have corrected what really bothers
you. You can always come back and have other things done.
 Benefits
The benefits of neck lift surgery are
the rejuvenation of the neck and the re-creation of a sharp,
youthful cervico-mental angle. Here is a brief list of the
benefits provided by neck lifting:
- Re-creation
of sharp neck (cervico-mental) angle.
- Rejuvenation of neck.
- Dramatic reduction or elimination
of turkey neck banding in neck.
- Defining the jaw line like that seen
in the youthful neck.
- Dramatic improvement or elimination
of lax skin and wrinkles within the neck.
- Correction of double or triple chin.
- Creating a longer more elegant appearing
neck.
- Scar placement can be done completely
behind the ear, virtually unnoticeable.
 |
| Incision
is positioned within the crease behind the ear making
it unnoticeable even when the hair is styled back. A second
small incision is placed in the crease below the chin. It, too, becomes almost unnoticeable with time. |
Are
you a good candidate?
Anyone who
has acquired a lax neck where the skin no longer holds tightly
against the “Adams Apple” is a good candidate
for a neck lift. Despite the fact that aging affects the
entire face, it is not uncommon for the neck to show the effects
of aging earlier than that of other areas. Therefore, depending
on your situation only a neck lift may be required to obtain
the degree of facial rejuvenation you are looking for. Here
is a brief list of good candidates for neck lift surgery.
- Lax neck skin.
- Turkey neck banding within
the neck.
- Loss of sharp neck (cervico-mental)
angle.
- Loss of jaw definition.
- Double or triple chin.
- Your neck looks shorter and older
than it used to.
Do's
and Don'ts prior to surgery
-
Medications. Certain medications thin your blood and should not be
taken within three weeks of surgery. The most notable
is aspirin and aspirin containing products. Vitamin E
and many herbal products also thin the blood and should
not be used within 3 weeks of surgery. Your plastic surgeon will
go over this more thoroughly prior to the procedure.
-
Sleep. It is important to get a good night's rest prior to the
procedure. If you think this may be a problem, please,
do not hesitate to ask your doctor for something to help
you sleep.
-
Smoking. Do
not smoke within 3 weeks before and after surgery. Smoking
has a profound effect on reducing wound healing capabilities. It
significantly increases the likelihood for infection,
wound healing problems, and scar formation. It also affects
your airway, therefore, makes anesthesia much more difficult.
-
Eating. Do
not eat within 8 hours of surgery and do not drink within
6 hours of surgery. It is OK to take medications with
a sip of water. Please discuss allmedications with your doctor and the anesthesiologist.
-
Washing. It
is a good idea to wash the surgical area thoroughly the
night before and the morning of surgery. Do not forget
to wash inside your ears just like your mother told you. Please
wash your hair the morning of surgery, comb it straight
back, and hold it in place. Do not apply any make up
-
Arrival. It
is best to arrive on time so things go smoothly. Please
be sure to have someone else drive you. The surgery can
not take place unless someone is there to drive you home
before the procedure starts.
-
State of mind. Remember,
this should be a happy and exciting time. A certain amount
of nervousness is normal but you should not be overly
concerned.
Anesthesia
The anesthesiologist will discuss with you what type of anesthesia
is best for you prior to the procedure. He/she will take into
consideration your medical history, the procedure, and your
personal wishes.
The type of anesthesia is up to you. Most doctors prefer
a general anesthesia and so do most patients, but local anesthesia
with sedation is possible.
After
the procedure
The procedure itself will take about
2 to 3 hours.
-
Immediately. Right
after the operation you will be watched for 1 or 2 hours
and encouraged to walk. Of course, there will be swelling and bruising but there
is surprisingly little pain. You will have a head dressing
on as well as ice packs to help keep the swelling down.
When you lay down you must keep your head elevated usually
on 3 pillows to prevent swelling.
-
That evening. It
is recommended that you take it easy. You can walk around,
eat, but not too much more. You must sit and lay with
your head up on at least 3 pillows. You will have a lightly
compressive dressing around your neck. This should be
worn continuously for 1 week and then at night for 6 weeks. This will help keep the swelling down as well with helping
the skin contract up against the underlying muscle. You
should take as much pain medication as necessary and try
to go to sleep early. Apply ice packs every 2 hours for
the first 24 hours. You will be given medication to help
keep the swelling down as well as to prevent infection.
-
First 48 hours. You
will be walking around easily. You should take a shower
the day after and gently wash your hair. Use a lot of
shampoo so that your hair lathers easily and then apply
a generous amount of conditioner. Just be gentle. The
incisions will continue to ooze for about 4 days. You
will see your plastic surgeon in the office approximately a week after the procedure
to make sure everything is healing well. For one week
you should wear the lightly compressive head wrap at all
times except, or course, when you shower.
-
First week. One
week after the operation you will have your first post-operative
visit. The majority of the bruising and swelling will
be gone by this time but complete resolution of swelling
takes 3-6 months. Finish the antibiotics prescribed. Begin
wearing your compression wrap just at night and do so
until 6 weeks after the operation. Begin applying SCARGUARD
to the incisions twice a day. This can be ordered on the
internet. SCARGUARD is a combination of steroid, vitamin
E, and silicone. It does a great job of decreasing redness
and scarring. Continue to apply until the redness is gone.
-
Beyond. Swelling
will not completely resolve for about 6 months but, as
mentioned above, the majority of it will be gone by 1
week. Skin contraction will not start until about 4 weeks
after the procedure and will continue to contract until
about 6 months. The final result will not be evident until
6 months when all the swelling has resolved and skin contraction
is complete but you will certainly notice a significant
improvement right away.
Recovery
time
The swelling and bruising will resolve in about 1-2 weeks. It is not unusual for people who work at home to start working
1 or 2 days after surgery. People with sedentary jobs go back
to work after 5 days. If your job, however, requires strenuous
activity then it may take as long as 3 to 4 weeks to return
to work. Most people return to work in about 1-2 weeks.
Consultation
We have outlined below what you can expect from your neck
lift consultation. Read carefully, as there are many suggestions
that will save you time, clear up questions, and help you
convey to your plastic surgeon what you want to accomplish.
Health
History
All cosmetic surgery consultations
begin with a thorough health history.This is especially
true if general anesthesia is being used, but also applies
to local anesthesia. Breast augmentations are usually done
under general anesthesia. Rarely, if the implant is placed
above the muscle, local anesthesia can be utilized. Prior
to meeting with your plastic surgeon you will be given a health history questionnaire
to fill out in the waiting area. There are five areas of
your health you will be asked about. Be sure to answer it
with detail so that your surgery and anesthesia can be optimized
for you.
General health problems are important
to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern
are: high blood pressure, diabetes, heart problems, liver
and kidney disease, stroke, cancer, bleeding problems, and
wound healing problems.
What will the plastic surgeon do
if I have medical problems?
In short, he/she will make sure your
health is optimized as much as possible to ensure your safety. This
may mean referring you to your private physician.
If you have a
health problem or are over 50 years of age you can often
save yourself time by getting a letter from your private
physician prior to your cosmetic consultation stating what
the health problem is, how it is being treated, and whether
or not you are able to tolerate general anesthesia safely.
If you are seeing
any specialist (cardiologist, kidney doctor, psychiatrist,
etc. ) be sure to bring a letter from them stating that you
are able to tolerate surgery.
If you are not able to tolerate general
anesthesia it may be possible for your breast augmentation
to be done under local anesthesia if the implant is placed
above the muscle. This must be discussed with your plastic
surgeon.
Be sure to let
your plastic surgeon know if you have ever had a blood clot.
On your questionnaire you will be asked
about previous surgeries. Be sure
to identify any problems you may have had with anesthesia.
Of particular concern are previous cosmetic surgeries especially
if you do not like the result and are interested in revision. With
breast augmentation it is especially important to mention
all breast surgeries including breast biopsies.
Be sure to list all medications you
take including aspirin and over-the-counter medications. These
are important as they may increase bleeding and affect your
surgery. It is extremely important to stop taking aspirin
and aspirin containing products at least 10 days before
surgery. Tylenol is a good alternative. Here is a partial
list of aspirin containing products and other products
to be avoided prior to surgery.
Information about medications that
cause allergies is very important so that these medications
can be avoided. Of particular importance is the reaction
you had, especially if you had trouble breathing. Be sure
to include this information! Nausea is not an allergy but
it is important to mention as well.
These three will certainly affect your
surgery and MUST be mentioned so that your surgery can be
optimized. Smoking causes a profound decrease in wound
healing and will lead to worse scarring and a less favorable
result. With large procedures such
as a face lift, neck lift, tummy tuck, and breast lift smoking
must be stopped at least 2-3 weeks before and after surgery.
Otherwise, the results could be disastrous leading to non-healing
wounds, poor scarring, and/or infection.
With smaller procedures such as eyelid surgery, nose surgery,
breast augmentation, and liposuction smoking will hurt the
overall result but this may or may not be noticeable. In
this case smoking cessation is strongly advised but is not
mandatory.
Neck lifting involves elevating the neck
skin. This puts a strain on the blood supply to the skin. Normally, this is not a problem but it may be in smokers.
Smoking significantly decreases blood supply to the skin and
can cause skin slough. The last thing you want after going
through a neck lift is a large scar from poor healing caused
by smoking. What Do You Want To Change?
It is important that you have a clear
idea of what you want changed when you go for consultation. The
least favorite thing a plastic surgeon wants to hear is: What do you think I need done?
Look in a mirror and identify what
bothers you. Be specific. It is helpful to break up the
neck region into three parts.
Evaluate each one of these areas individually
as this is what the plastic surgeon does in during the exam.
Common complaints
-
Chin:Too
small, too droopy (witch's chin).
-
Neck:Loose
skin, too much fat, neck platysmal bands (turkey neck).
-
Jaw:Jowling.
Ideal Neck
 |
Notice
how the entire face is affected by the neck lift
even though nothing was done to the face. Notice
the square, boxy look of the jaw in the before. Compare this to the youthful triangular look in
the after. Click to enlarge. |
-
Chin
-
Gives triangular shape to face.
-
Projects as far forward as the
lower lip in women and slightly farther in men.
-
The undersurface is flat, not
droopy.
- Neck
|
| Notice the dramatic improvement
of both neck angle and jaw line. Click to enlarge. |
Physical
Exam
The key to the neck physical exam is
to determine exactly what is causing the problem. Below
is a typical sequence that an experienced plastic surgeon
uses to evaluate the neck and what can be done to correct
problems.
The importance of the chin in relation
to the neck has already been outlined. See the section on
chin augmentation for more
information. With aging, some people develop a droopy chin
otherwise know as witch's chin. This can be corrected or
markedly improved during neck lifting. There are several
ways to address the problem but they all involve removing
the hanging fibro/fatty tissue that hangs below the ideal
chin level. This can be done through a small incision just
below the chin. Notice in the above Before and After pictures
the improvement of the droopy chin. The addition of a chin
implant greatly helps improve droopiness. Usually, as is the
case above, this is not necessary. Fat removal in combination
with a properly performed neck lift will obtain the desired
improvement.
Hanging skin below the neck is probably the most common
complaint. During your consultation, your plastic surgeon
will palpate the tissue to determine if the cause is excess
skin, fat, or muscle. Most commonly, it is a combination
of all 3, therefore, all 3 must be addressed.
This muscle is called the platysma and extends from above
the jaw line to the clavicle. It is responsible for skin
tightening. Men flex this muscle to tighten their skin
when they shave. This is the deepest layer, therefore,
during a neck lift it must be addressed first. With aging,
this muscle becomes lax and separates into bands under
the chin. These bands are excised through a small incision
just under the chin. They are sutured together in the
midline to create a smooth, continuous neckline. If necessary,
the muscle is then tightened laterally through an incision
behind the ears. Alternatively, the platysma muscle can
be suspended into proper position by a suture that extends
from one ear to the other.
2. Fat
Excess fat under your chin can be palpated
by pinching it between your thumb and index finger. This
fat can be removed either by excision or liposuction. Fat
excision is performed through the same incision under the
chin that platysmal tightening is accomplished.
|
| Example
of patient with a significant amount of fat and jowling. Also notice prominent chin (witches chin) and its correction
in the After picture. |
3. Skin
Loose, hanging skin is tightening laterally
through an incision behind the ears. The excess skin is removed. The
length of incision behind the ear depends on how much redundant
skin is present. With minimal or moderate amounts, the excision
may be completely hidden behind the ear. With a large amount
of skin excess, the incision may extend posteriorly into the
hair-bearing scalp. See picture of typical incisions below.
Jowls are fat deposits that have sunk below the jaw line. In
youth, this fat was positioned up in the cheek where it
belongs. With age, like all facial fat, it descends. It
hides the jaw line and gives an unattractive square shape
to the jaw instead of a more attractive triangular shape. It is best addressed by elevating it back into its cheek
position via a face lift. Significant
improvement, however, can be accomplished with liposuction
performed at the same time as a neck lift.
Typical Neck Lift Incisions
|
| Incision
is positioned within the crease behind the ear making
it unnoticeable even when the hair is styled back. A second
small incision is placed in the crease below the chin. It too becomes almost unnoticeable with time. |
|
