Neck Lift (Lower Rhytidectomy)

As insignificant as the neck may seem in comparison to other areas of the body, the neck is an important aspect of a person’s entire look. Neck lifts can offer very dramatic results for those seeking a more youthful appearance. This procedure is undoubtedly one of the most effective treatments available for eliminating sagging skin, smoothing deep wrinkles, and rejuvenating the neck area with a sleeker, more attractive look.

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Summary

Mention plastic surgery, and most people will probably think of facelifts, breast augmentation, rhinoplasty, or other more commonly known surgical procedures. Neck lift surgery, on the other hand, is usually one of the lesser known cosmetic surgeries, which can be quite surprising given the effectiveness of the treatment.

The relative obscurity of neck lift surgery in pop culture is probably due to the relative insignificance of the neck area itself. While the eyes, nose, mouth, and other facial features are the most prominent focal points of a person’s appearance, the neck is more of a complementary feature that can easily go unnoticed. Additionally, the scars and other signs of surgery can be very well-hidden, and the results look very natural. This can be quite a blessing for those seeking a discreet way to improve their appearance with plastic surgery. After all, unlike other procedures, having the surgery isn’t likely to be obvious to anyone but the person who’s had it done.

Overview

While cosmetic plastic surgery has been known to exist for centuries, the cosmetic procedures we’re most familiar with today really began taking shape over the last few decades. In American society, cosmetic plastic surgery began gaining popularity in the 1920s and was met with sharp criticism from doctors against these purely elective procedures, and from people shocked at the idea of vanity being taken to such extremes.

Today, plastic surgery is exceedingly commonplace, and the advancements in modern medicine have made these procedures safer, more effective, and much more accepted as a cultural norm than ever before. Though the taboo around plastic surgery is mostly gone, there can still be somewhat of a stigma attached to having “work done,” and many people would prefer to keep quiet about their decisions to operate if given a choice.

Neck lift surgery is one of the less-obvious forms of plastic surgery that exist, making it the perfect choice for those seeking a subtle way to enjoy dramatic enhancements to their appearance. According to a report by the American Society of Plastic Surgeons (ASPS), there were 53,028 neck lifts performed in the US in 2017 alone. Candidates for neck lift surgery are typically individuals that want to tighten the skin around their neck or eradicate jowls, deep wrinkles, or sagging skin, and the procedure is sometimes performed along with a full facelift.

What is a Neck Lift?

In general, neck lift surgery is primarily designed to enhance and tighten the neck, eliminating excess tissue, fat or banding that often forms as we age. The appearance of a chubby neck, double-chin or a wobbly neck is typically caused by three of the following factors: a lax platysma muscle, excess fat, and the presence of a large fold of excess neck skin, commonly referred to as a turkey wattle.

Direct neck lift surgery essentially combines two different neck rejuvenation surgeries into one procedure: a cervicoplasty, and a platysmaplasty. Both of these procedures are performed specifically to target specific areas of the neck and under the chin and can be performed alone if the patient is trying to correct less severe effects of aging.

More commonly, both procedures are combined in a direct neck lift when a more invasive surgery is necessary for correcting more serious signs of aging, and heavily drooping neck skin.

What Types of Neck Lift Surgeries Are There?

A neck lift surgery isn’t a one-size-fits-all operation. Instead, it’s a customized procedure designed exclusively for each individual patient. In other words, your plastic surgeon will evaluate your case and determine which of the following surgeries to perform in your neck lift surgery, according to your needs:

Direct Neck Lift An incision is placed underneath the chin, where the sutures and any scarring will be easily hidden from view. Once a small incision is made, the skin of the neck will be elevated to expose the underlying fat. The fat is then removed either directly or with liposuction. Once this is completed, the lax, underlying platysma muscle is tightly bound with sutures. These sutures will allow for significant structural support for the neck and a more defined and streamlined neck angle.

Once the fat is successfully removed, your doctor will move onto the second part of the neck lift surgery. A large fold of excess skin is completely removed using a special plastic surgery technique called a vertical-z incision. The vertical-z incision is strategic and allows for the edges of the skin to flap out and fit neatly together again, to allow for quick and comprehensive healing after surgery is complete. A compression garment must then be worn diligently for several weeks after the surgery is completed.

Platysmaplasty Platysmaplasty involves surgical reconstruction of the neck muscles called the platysma. It is performed specifically to rejuvenate both the neck area and under the chin. The platysmaplasty neck lift begins with a very small, hidden incision beneath the chin, measuring approximately one centimeter in length. Special endoscopic instruments are used to remove the excess fat in the center of the neck, while reducing and tightening the excess loosened platysma muscles by suturing them into a single sheet of muscle, called a midline platysma plication. This single sheet of platysma muscle will then be a resistant barrier to keep neck bands from forming.

The procedure works best when there is moderate aging of the neck, and when patients are in their forties to late fifties. An isolated platysmaplasty is not recommended for patients with more significant aging and heavier drooping in the neck, as it then must be combined with a cervicoplasty in a direct neck lift surgery for better results.

Cervicoplasty Cervicoplasty is a minimally invasive surgical procedure that seeks to remove excess skin underneath the chin or neck. The area is infiltrated with a lidocaine and epinephrine solution.

In this surgery, a small, well-hidden z-plasty incision under the chin is made, and a small suction probe is inserted underneath the skin. Once the suction probe is inserted successfully, the doctor will begin removing excess fat from the area, while leaving the muscles underneath the chin and the neck intact.

A cervicoplasty is not recommended for patients who also need to address muscle laxity in the neck or have a significant amount of excess fat in the chin and neck area. It is also not recommended for those with more serious signs of aging that might benefit from a more invasive procedure than cervicoplasty.

Do I Need Neck Lift Surgery?

A neck lift is a surgical solution to improve visible signs of aging in the jawline and neck. Youthful contours in the neck and face can be lost due to a variety of factors, such as stress, weight gain, environmental conditions, and heredity.

When the neck or chin areas seem to stand out or look out of proportion with the face or the chest, or if a patient is embarrassed by excess skin, heavy wrinkles or other signs of aging, neck lift surgery can help to effectively balance and smooth out the neck and chin areas.

Here are some common problems that cause many to choose neck lift surgery as a solution:

  • Excess fat and skin relaxation in the lower face that creates jowls
  • Excess fatty deposits underneath the chin
  • Loose neck skin
  • Muscle banding in the neck, which creates abnormal contours

Neck lift procedures are designed to suit the needs of each patient on an individual basis. If you feel that you might benefit from a neck lift, ask for a consultation with a plastic surgeon that is a certified member of the American Board of Plastic Surgery to determine whether this procedure is right for you.

What Benefits Can I Expect From Having Neck Lift Surgery?

The goal of your neck lift procedure will depend on the components of the surgery your doctor has planned for you. Your surgery will either seek to reduce or remove excess skin underneath the chin area in a cervicoplasty, or it will work to tighten the platysma muscles to enhance definition in a platysmaplasty. In many cases, your doctor will perform both procedures in a direct neck lift operation.

If your goal is to lessen the look of a double chin, remove fat or excess skin (more commonly known as a “turkey neck”), smooth-out wrinkles and reduce heavy creases, you are likely to see excellent results from a neck lift procedure.

The benefits of a neck lift procedure are typically long-lasting, natural-looking, and permanent. A neck lift can also be combined with a facelift for a more comprehensive facial revitalization.

Who is the Ideal Candidate for Direct Neck Lift Surgery?

The ideal candidate for a direct neck lift is generally someone that is bothered by signs of aging in the neck area and is a healthy individual. Doctors also recommend that neck lift patients are nonsmokers and do not have allergies to anesthesia, certain medications, or other complications that might make the surgery or the healing process difficult.

Ideal candidates will also have a positive mindset regarding surgery and will hold realistic expectations about the outcome of their procedure.

Who Should Not Have this Procedure?

A direct neck lift is not recommended for patients with severe jowl or cheek sagging that might better benefit from a facelift or other type of procedure. Also, a neck lift is not suitable for patients with very thin skin that cannot be stretched or that lacks a certain degree of laxity, as the neck lift surgery process requires stretching of the skin.

Neck lift surgery, like any cosmetic procedure, is not recommended for candidates with unrealistic expectations about results. It’s advised that patients are made aware of what to expect from a neck lift, and what cannot be improved with the surgery. To clarify, a neck lift operation will not change your fundamental appearance, nor will it completely stop the inevitable aging process from taking place. For a better idea of what to expect from surgery, ask your doctor to discuss what staying realistic will mean for your individual situation.

Patients with a medical history of complications, especially heart conditions, or allergies to anesthesia may not be suitable for neck lift surgery. Additionally, those with unrealistic expectations about surgery would not be recommended for a neck lift procedure. Those that smoke will be encouraged to quit several weeks or months before the procedure to avoid complications during and after surgery.

Will I Be Put Under Anesthesia During My Direct Neck Lift Surgery?

Yes. In neck lift surgery, the patient is put under anesthesia during the operation. Your surgeon will recommend the best choice of anesthesia to ensure your comfort and safety throughout the procedure. In most cases, patients are sedated intravenously or put under general anesthesia.

How Will I Prepare for my Direct Neck Lift Surgery?

In most cases, your doctor will advise you to begin preparing for surgery up to two weeks in advance. In general, you’ll be instructed not to take anti-inflammatory pills and over-the-counter pain relievers, such as aspirin, ibuprofen, and Advil. Patients will also be advised to cease the ingestion of certain vitamin supplements and multi-vitamins, herbal teas and herbal medications to decrease the risk of bleeding.

Patients should not smoke at least two weeks before a neck lift, or drink alcohol five days prior to the operation. They should also stop taking Retin-A creams and Accutane (isotretinoin), birth control medication and hormone treatments two weeks before the surgery date.

Your doctor will instruct you to take any lab tests he or she may need to perform the surgery, and prescribe several medications to begin taking beforehand. Your doctor may also prescribe a dedicated face washing routine to be completed daily in the days prior to surgery, in order to prepare the skin for a neck lift.

The night before surgery, patients may be advised to take a pain medication like Valium, though this is sometimes administered the morning of the surgery. You’ll also be instructed to abstain from eating or drinking anything after midnight on the day before your surgery.

Patients will need to arrange for care from a friend or family member before neck lift surgery. In most cases, patients can expect to need assistance at home for at least two full days after surgery happens, starting with the drive home.

What Should I Expect After Surgery?

After surgery patients should expect to feel a little pain in the form of tightness or soreness in the treated areas. To manage pain, the doctor will prescribe pain medication. Other symptoms after surgery include numbness, tingling sensations, mild swelling, and some bruising, though these symptoms are usually minimal.

Patients should not take aspirin or resume certain medications after surgery, according to their doctor’s recommendations. You’ll also be advised to start walking as soon as possible to encourage blood flow, which will help to keep the swelling down and reduce your chance of potential blood clots from forming.

Patients should know not to smoke or drink alcohol for an extended period of time after neck lift surgery, according to their doctor’s instructions. Smoking and alcohol consumption can delay the healing process, and could maximize the risk of other complications after surgery. You’ll also be advised not to drive a car until you’re able to stop taking narcotics for pain, which may take at least a week after surgery.

Patients should also refrain from the following activities at least two weeks after surgery:

  • Strenuous exercise and sex
  • Heavy housework
  • Alcohol
  • Smoking
  • Steam baths, saunas, or jacuzzis
  • Excessive sun exposure
  • Hair dyes and permanents

In most cases, patients can expect to return to work and other regular activities two or three weeks after surgery. Your doctor will consult with you on your expected recovery times before your neck lift, and at the follow-up procedure after surgery. He or she will also discuss proper care for your sutures and neck area, including the use of steri-strips over the incision and cold compresses for swelling.

Potential Side Effects or Complications from Neck Lift Surgery

As with any cosmetic surgery procedure, there are several potential side effects that can occur after a neck lift. Side effects can vary depending on the medical history of the patient, and the type of procedure that has been planned.

Some side effects and complications include light swelling and bruising, general discomfort and mild pain, changes in sensation in the treated areas, and in some cases, scarring.

Rare but potential risks and complications after neck lift surgery include allergic reactions to anesthesia, bleeding, hair loss where incisions were made, asymmetrical or uneven lines in the neck and facial areas, infection, hematoma, and a very slight risk of a specific nerve injury near the lower lip.

To minimize your risk of any potential complications occurring after surgery, it is essential to follow the advice and instructions of your surgeon for best results.

How Much Does Direct Neck Lift Surgery Cost?

The cost of a direct neck lift will depend on a variety of factors, such as the experience of the surgeon, the type of procedure used and the geographic location. Prices usually start at around $5000 and can be as much as $8000.

Neck lift costs may or may not include:

  • Anesthesia fees
  • Hospital or surgical facility costs
  • Medical tests
  • Post-surgery garments
  • Prescriptions for medication
  • Surgeon's fees

Usually, neck lifts are cosmetic and elective, rather than restorative surgeries. This means that in most cases, your health insurance plan will not provide coverage for a neck lift procedure. In any case, plastic surgeons generally offer patient financing plans, so be sure to ask for those if you are interested in learning about more payment options.

Are Results Permanent or Temporary?

Results of a neck lift are permanent, and results are typically noticeable immediately after surgery is completed. However, patients should know that it may take several weeks or even months after surgery for swelling, bruising, or other symptoms to fully subside. As the side effects begin to fade off, results of the cosmetic surgery will become more noticeable. Bear in mind that your results may be affected by the natural aging of the skin. This is normal and to be expected.

Conclusion: The Pros and Cons of Neck Lift Surgery

As discussed, neck lift surgery can be advantageous in improving the appearance of the neck area in patients where signs of aging are advanced. It can also increase confidence and give the patient a more youthful appearance.

In general, neck lift surgery has many benefits when applied to the right candidate, and patients are usually very satisfied with their results. Patients can experience improvements in definition and contouring, a reduction in fullness and excess fat, and removal of a double chin and turkey neck.

The drawbacks of neck lift surgery include the possibilities of visible scarring, the risk of various side effects and complications, and an overall ineffectiveness for those with poor skin elasticity.

Different Types of Neck Lift (Lower Rhytidectomy)

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