The Truth About ‘Mini’ Neck Lifts

Here are the possibilities, limitations, and misconceptions you should know before booking a ‘mini’ neck lift, according to top plastic surgeons.
Aesthetics
Written by Kaitlin Clark
03.16.2021
The Truth About ‘Mini’ Neck LiftsAngélica Echeverry/Unsplash

My grandmother always used to say that you can tell a person’s real age by taking a good look at their neck. One of the most delicate areas of the body, the neck has thinner skin than the rest of the body, causing the area to reveal signs of aging earlier and quicker than the face. These changes in skin quality, often visible in our early to mid-thirties, are notoriously difficult to reverse without surgical intervention in the form of a neck lift … and all of its baggage, including a three to four month healing period.

So, when a ‘mini’ neck lift started gaining traction in doctors’ offices, it sounded incredible: a mini solution to a maxi problem. It’s said to be less invasive with a shorter recovery and fewer risks, yet it yields similar results to its more serious sister. But things that sound too good to be true often are, and many plastic surgeons are calling the ‘mini’ neck lift a misnomer.

What Is a ‘Mini’ Neck Lift?

“The shortest answer I can give you is there really is no such thing as a mini neck lift, per se,” says Adam Kolker, MD, a New York City-based board certified plastic surgeon. “You will not go to a plastic surgery textbook of any kind and find the chapter on mini neck lifts. It does not exist.” But that’s not to say there aren’t procedural stepping stones on your way to a full blown neck lift. “On the flip side, you can now establish a hierarchy — or a treatment ladder — that will address one, several, or all of the issues,” he notes.

Moving from the lowest rungs of a ladder (i.e. the suite of non-surgical options to reverse signs of aging in the neck), Dr. Kolker explains that each step signifies a more invasive solution until reaching the pinnacle: a full, traditional neck lift. “Rather than calling it a mini neck lift, there are minimal access points or minimally invasive corrections for neck laxity,” he offers.

The Pros and Cons of a Mini Neck Lift

Considering this sliding scale of neck procedures that a mini neck lift could entail, we asked three renowned plastic surgeons to explain everything someone can expect with a ‘mini’ neck lift, from the goals to the limitations — and everything in between.

1. It CAN’T be performed on everyone

“With the neck in particular, you have to be very careful to do a complete history and physical examination,” says Dr. Kolker, who explains that the clinical examination will reveal key factors about a patient’s viability, including the elasticity or inelasticity of the skin, the amount of extra fat underneath the chin, and the visibility of the platysma muscle (i.e. the vertical band connecting the jaw to the collarbone that’s also visible when someone flexes their jaw).

“It depends on the individual’s anatomy and desires and to choose the most minimally invasive approach that will satisfy their needs over the term they’re hoping to achieve the durability of the result,” he says. In some cases, the exam will reveal that an alternative procedure can satisfy their goals better. “Is everyone who is 40 to 45 years old with early signs of excess skin in the neck a candidate for a neck lift,” Dr. Kolker asks. “The answer is no — they don’t necessarily need to do that yet.”

2. The procedure CAN vary from patient to patient

“There’s kind of a spectrum of addressing the neck,” explains Thuy-Van Tina Ho, MD, a double board certified facial plastic and reconstructive surgeon who runs a private practice in Philadelphia. “It’s all about phrasing too, right? How I would define the mini neck lift could be very different than other surgeons out there.”

For Dr. Ho, a mini neck lift is a “step down” from a neck lift. She defines it as a procedure where “less skin is elevated,” but the surgery specifics will vary from patient to patient. “One particular procedure never works for all people,” Dr. Kolker adds. “It’s got to be very uniquely tailored to the individual.”

According to Dr. Ho, in a mini, the “muscle layer may not be addressed or a limited platysmaplasty may be pursued, just some simple suturing, but no major undermining,” in patients whose neck bands are showing some slack. A “limited SMAS suspension could be performed as well,” she says, depending upon the extent of sagging along the jawline.

3. It CAN be effective for mild jowling and sagging skin

Realistic expectations are crucial to any successful aesthetic surgery, and, with mini neck lifts in particular, all parties need to carefully align on what is a reasonable outcome. “You do achieve definitive results, but not as dramatic or drastic compared to a traditional neck lift,” Dr. Ho notes. “Patients who have mild neck issues and aging neck issues — like mild skin laxity or fullness in the chin or neck area or platysmal banding issues — could be a good candidate.”

But the procedure, however customizable, has its limits. “If someone has heavy or even moderate skin laxity, this isn’t the procedure for them,” she shares. “It’s not going to fix it.”

4. It CAN be done in tandem with other modalities

“None of these surgical procedures do anything for skin quality,” says NYC-based board certified plastic surgeon Steven M. Levine, MD. But there are energy-based treatments that can support neck rejuvenation, particularly crepey-looking skin, which is notoriously difficult to neutralize. “I think there’s a role for general neck resurfacing and anything you can do to improve skin quality,” he says. Fraxel®, fractional ablative laser, radiofrequency microneedling, and chemical peels can all “improve skin quality,” he adds.

5. It CAN’T tighten or fix fine lines or wrinkles on the neck

“The crepiness and fine lines in the neck are probably the hardest things to manage,” Dr. Kolker says. So, while you can improve tone on the neck with a mini lift, the lack of collagen and elastin in that area means you “can’t really tighten that area up that much, unless you move to the more surgical end of the spectrum,” he explains. Even at the most aggressive end of the mini neck lift spectrum — which typically involves traditional liposuction or a liposuction with radiofrequency assisted lipectomy (RFAL) — is “not going to tremendously improve the quality of the skin if you’ve got a significant amount of excess,” he cautions, because the sagging skin is not removed.

6. It CAN have unpredictable results

There’s no such thing as a sure thing, especially in plastic surgery. That rings even truer when there is not one codified, board-approved definition of what a mini neck lift entails and, thus, no established optimal outcome. “For the average woman, we’re talking about a tiny incision underneath the skin with radiofrequency and suction-assisted lipectomy, which is going to give you a small improvement,” Dr. Kolker explains. “Sometimes the improvement is as small as 10 or 15 percent. Sometimes it’s as much as 30 or 40 percent.”

An ideal candidate for a “limited incision procedure” (Dr. Kolker’s preferred term for the more serious end of the mini neck lift spectrum) is someone with good skin elasticity. With only small incisions under the chin and without removing any excess skin, the procedure’s success is entirely reliant upon the skin’s ability to bounce back, meaning that outcomes and results will vary based on how well skin constricts and reshapes during recovery. For this reason, such procedures are “appropriate only for very, very mild excess,” he warns.

7. It CAN’T correct significant neck sagging

Not sure if a small incision neck lift is right for you? According to Dr. Levine, it’s quite simple to determine. “If you have a lot of loose skin and poor skin elasticity, then you need a procedure that will also remove and tighten loose skin, which is a more traditional neck lift,” he says.

Deep neck contouring may also be necessary. “It addresses deep fat, which is a very different kind of fat than regular liposuction,” he says. He describes deep neck contouring as a limited incision procedure to remove the fat and glands beneath the platysma muscle in order to “create extra space in the neck for the neck skin to contract over and give a more chiseled jawline.” This procedure can be performed independently as a smaller-scale neck procedure or added onto a full neck lift or facelift.

8. It CAN include a chin implant

Surprisingly, a chin implant is on the medical list of neck enhancement procedures. “Sometimes people have neck laxity because they have a diminutive or underprojected chin,” Dr. Kolker shares. In these cases, “some combination of either suction or radiofrequency with a small chin implant has a very powerful effect on the neck skin because you’re using an implant to tighten the skin of the neck up by pulling that neck skin forward without making bigger incisions,” he explains. At the same time, you can also address excess fat. “By changing the architecture of the neck, you’re also improving the appearance of the neck and the jawline for a more contoured look,” he says.

9. Patients CAN age out of eligibility

According to Dr. Levine, the restrictions for the more invasive end of minimal incision neck lift procedures — like superficial liposuction and deep neck contouring — are tied to the more advanced signs of aging. “The limitations of these liposuction procedures are based on how elastic someone’s skin is because you’re relying on contraction and the skin’s contractility,” he says. “The more elastic the skin is, the better result you’ll get.” As such, he says it’s generally a “great option” for someone in their thirties, forties, and even fifties. “Some people can have great elasticity in their sixties,” he says. “But, as you get older, you have to evaluate based on the specific patient.”

10. Results CAN’T offset the effects of an unhealthy lifestyle

“Once you hit the recovery room, the aging process resumes that moment,” Dr. Kolker notes. “If people are predisposed to change or if their lifestyle predisposes them, like sun exposure or smoking, then obviously you’re going to see a little bit less durability than someone who eats clean, is fit, and takes care of their skin and weight.” At the end of the day, he says any elective surgery is a “small piece of the puzzle” and healthy lifestyle choices are “the most important to make the results last longer.”

11. You CAN’T expect zero side effects

The term ‘mini’ is often thought to imply less downtime and invasiveness, but don’t let the word fool you. “I’ve even heard it called a ‘weekend procedure,’ which is wrong,” Dr. Ho cautions. “It’s still a surgery and the risks are similar, if not the same, as a traditional neck lift.” To heal properly and correctly, “you need to take it seriously,” she adds.

Although each patient’s recovery will look a bit different, Dr. Ho says that it’s safe to expect bruising and swelling for the first few days post-op. In some cases, it can last for as long as two weeks. Exercise is also off limits for 14 days, and Dr. Ho gives her patients strict instructions for how and when to wear the post-op compression garment. “These precautions are going to be the same, regardless of whether it’s a full or mini,” she says.

12. It CAN exacerbate other neck concerns

A superficial liposuction — that is, the removal of fat that covers the platysma muscle bands — can successfully address a full-bodied neck in patients who are candidates, but it isn’t as simple as it sounds. “You have to be so careful with necks,” warns Dr. Levine, who recommends booking a neck procedure with a board certified plastic surgeon who specializes in treating the face and neck. If superficial lipo isn’t carefully performed, there may be negative consequences down the road because “you’ve removed the layer of fat that camouflages the platysma muscle, and the visible bands are what people don’t like” he says.

So, while you’ve addressed one concern, you may have exacerbated another. “As we age, we lose fat in the neck and the platysma becomes more obvious,” he notes. “You’ve improved the neck contour at the expense of making the neck bands more visible.”

13. It CAN’T provide long-lasting results

For neck procedures that remove fat via superficial liposuction, RFAL, or deep neck contouring, Dr. Kolker says a patient can expect the results to last somewhere in the neighborhood of five to 10 years, depending on lifestyle factors — though the removal of the fat cells is permanent.

Dr. Ho adds that many of her patients seeking a mini neck lift are looking for a smaller-scale solution, not the dramatic improvement or neck contour of a traditional neck lift. As such, the results are “definitely not going to last as long” as a full neck lift because it requires less surgical intervention, she says.

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KAITLIN CLARKis a freelance writer for AEDIT.

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