Do You Need To Combine A Neck Lift With A Facelift?

You’ve seen it before: a woman with a gorgeous jawline that is accompanied by a crepey, saggy neck that doesn’t match. This exact look is why many plastic surgeons perform a facelift with a neck lift. Together, the two procedures create a harmonious, well-balanced look. But, like everything in life, there are exceptions to the rule — be it few and far between — when one procedure is necessary and the other is not. Below, we’re breaking down everything you need to know about combining face and neck lift surgeries.

Why Does the Neck Age So Fast?

We all age at different rates, but you can count on one thing: the neck tends to age faster than the face. Here’s why:

1. Weight Changes

Gaining weight in the lower face is just one factor that speeds up aging in the neck. “Weight often shows in the neck, and those that lose weight may not see their skin shrink back down, which results in a ‘turkey neck’ appearance,” says Peter Vila, MD, a board certified facial plastic and reconstructive surgeon in San Rafael, CA. However, thinner patients without extra fat in the chin and neck area face their own set of concerns. Dr. Vila reveals that loose skin has a tendency to sink into the most dependent point of the face and neck — the area right under the chin — again resulting in a turkey neck. His advice to patients whose weight fluctuates: try to lose as much weight as possible before surgery. “This way, the skin can be tailored when it is most ‘deflated,’ and I can remove any extra fat via liposuction,” he shares.

2. Skin Quality

But it’s not just fat that accelerates aging. The skin quality — or lack thereof — also affects the appearance of the neck. Stafford Broumand, MD, a board certified plastic and reconstructive surgeon in New York City, notes that the neck tends to display early signs of aging because the skin is thinner. Plus, the neck lacks as many oil glands as the face does. Natural oils hydrate the skin, and hydration is essential for skin health, says David Shafer, MD, an NYC-based board certified plastic and reconstructive surgeon.

Of course, collagen plays an essential role in the skin on the neck, too. Thick, healthy collagen equates to plump, taut skin. But since there is less natural collagen in the neck than in the face (or elsewhere on the body), the skin is not nearly as elastic or resilient. For this reason, fine lines and banding surface early on. Sun exposure, which destroys collagen fibers, also takes its toll.

Sadly, for most of us, the neck is not treated with the same TLC as the face, although it is best to treat it as an extension. While we are diligent about applying sunscreen to your visage, most of us are not as good at applying it to our necks. The result? More sun damage, says Jacob Unger, MD, a board certified plastic and reconstructive surgeon in Nashville. It is, however, never too late to take care of the delicate skin on the neck with sunscreen, retinol, moisturizer, and even the occasional radiofrequency-based skin-tightening treatment.

3. Muscle Tone

Couple loose skin with neck bands and the neck can age you by up to 10 years. Dr. Shafer says that, with age, the platysma (read: neck) muscles loosen and separate in the midline (similar to what can happen with the abdominal muscles post-pregnancy). As he explains, the loss of muscle and tissue support from the platysma leads to jowls, low-strung platysmal bands, and a blunted, obtuse neck angle. “Part of the goal of a neck lift is to sew the platysma back together to define the cervical mental angle,” he shares. “Additionally, in a SMAS facelift, the upper portion of the platysma, which extends onto the face, is tightened to restore youthful muscle position.”

4. Technology

And then there is the fact that we are all glued to our phones. So-called tech neck causes pain and wrinkling from bending our heads to look at computers, tablets, and smartphones, says Mark M. Hamilton, MD, a board certified facial plastic and reconstructive surgeon in Indianapolis. “This downward tilt of the face and neck leads to early and excess wrinkling in the lower neck and chest,” he adds.

But that’s not the only way technology is affecting the area below the jaw. The 'Zoom effect' is alive and well, says Adam Kolker, MD, a board certified plastic and reconstructive surgeon in NYC. People have spent the last 18 months seeing themselves on-screen with jowls, neck folds, and creases they may not have noticed IRL. “With cameras positioned too low, this often prompts emergency calls to a plastic surgeon, but these effects are not permanent,” he explains. So perhaps limiting screen time isn’t such a bad idea after all, especially if it has an anti-aging benefit.

Combination Procedures: A One-Two Punch

When rejuvenating the face and neck area, it’s hard to treat both features with just one procedure, especially if the face and the neck show evidence of loose skin, displaced or excess fat, and poor muscle and tissue support. On their own, a facelift surgically corrects signs of aging on the face from the jawline up to the lower or midface. A neck lift, meanwhile, tightens skin from the jawline down, while removing redundant fat and tissue.

Hands down, a neck lift is a tried-and-true method for achieving a super tight, smooth neck. Most surgeons incorporate a neck lift into every facelift they do. “The vast majority of patients that need neck correction also need lower facial rejuvenation,” Dr. Hamilton shares. “Thus it is rare for a surgeon to recommend for a patient to select a neck lift alone.”

Yet, the decision to pair a facelift into a neck lift comes down to the best approach for you and your concerns. “We often perform facelifts and neck lifts contemporaneously as the face and neck are married by the aging jawline," Dr. Kolker says. Whether the face and neck are aging at the same or different paces, addressing one without the other will distort the outcome. “If one area slightly outpaces the other but both areas show signs of aging, lifting only one can be like painting one room in an old house,” he cautions. “The room right next to it will look like it needs a fresh coat even more.”

Simply put, correcting just the face and not the neck (or vice versa) highlights any imperfections, and the signs of aging will start to become more noticeable than before. “For most patients, addressing the neck without addressing aging in the lower face creates a notable difference between the appearance of the two, which is why most surgeons typically recommend rejuvenating both the face and the neck,” states Dr. Hamilton.

The criteria for considering a neck lift with a facelift:

• Your neck and face both make you feel and look older than you are
• The neck doesn’t match the face in terms of tautness or vice versa
• You don’t want to undergo multiple procedures in the future
• There is sagging in the lower face, under the chin, and on the neck

Excess fullness and skin in the area under the chin and jaw is what Dr. Vila looks for in a neck lift patient. In the case of a facelift, “the signs are jowling and a deflated look to the face,” he adds. A lack of distinction between the jawline, chin, and neck area is usually the final determining factor to perform both procedures. “Though patients may consider the two procedures to be completely separate, I view them on the same spectrum,” he shares. “It’s just that different patients require different components, and some patients require all of them.”

Rarely are there instances when only a facelift is necessary — though they do exist. “If there is facial laxity and soft tissue descent to the jawline region with minimal cervical laxity or deformity, no neck lift is required,” Dr. Kolker explains. “Most often, by resuspending the SMAS and platysma, the muscle that covers the lower two-thirds of the face and most of the anterior neck, mild neck contour issues and laxity are often corrected.” But, if moderate or severe laxity is not corrected, chances are you'll be back in the operating room to fix the now more prominently aging neck.

Sometimes, a preventative approach to aging uses Botox® to diminish prevalent neck bands or filler along the jawline to create definition (i.e. add more distinction between it and the neck). Even so, these areas still tend to require surgical intervention, albeit at a later date. “After a facelift, Botox® and filler are useful in maintaining the surgical results,” Dr. Shafer shares.

Like other surgical procedures, the facelift-neck lift combo has evolved. “Over the years, we have learned to do two important things,” Dr. Unger says. The first involves facial volume. “One is almost always to add fat to the face to replace areas that have lost volume due to the aging process,” he explains. “By adding volume, we can re-elevate areas of the face that have fallen for a more balanced and harmonious look.”

The second lesson has to do with technique. Surgeons now take what Dr. Unger calls “a more anatomic approach” to facial rejuvenation. “Instead of just pulling on the skin and trying to make things tighter, we now focus on re-creating the natural contours of a more useful face by rearranging the anatomy on a deeper level than the skin,” he explains. “This creates a more natural appearance for longer-lasting results.”

The Takeaway

Chances are, if you are seeking surgery to correct your aging face, you’re going to want to address your neck, too. Rarely do plastic surgeons restore one without the other (though that doesn’t mean it can’t happen). “If only the face is corrected and not the neck, then the patient can look older because the neck skin will continue to sag,” Dr. Shafer says. There will also be an evident disconnect between the neck and face. “If the neck is corrected and not the face, the patient can get a bobblehead appearance with a tight neck and a fat face,” he adds.